The use of cancer care pathways aims to improve patient outcomes by prioritizing provider prescribing to high-value evidence-based treatments and therefore reduce the use of expensive therapies that could be more toxic and/or marginally effective. With the rapid development of new treatments in oncology, especially in targeted therapies and immunotherapy, and the increase in cancer care options, it can be difficult for oncologists to keep up with the evolution of prognosis, available medications, and their potential side effects. The addition of care pathways may be a way to provide physicians with a comprehensive and clinically relevant decision support tool.
Cancer centers and hospital networks utilize care pathways to help standardize diagnosis, treatment, and management of the most common cancer types. There are many factors that impact what type of pathway vendor/program that is utilized in each organization. These factors could include ease of use; cost to purchase, implement, or manage; and the level of support provided by the vendor and internal practice resources. Based on internal data, approximately 30% of US practice sites use care pathways for cancer patients, however less than 10% have a pathway integrated into the electronic health record (EHR) for seamless clinical decision support. This highlights the opportunity for improved synergy between pathways and EHR and a renewed focus on EHR placement as the true access barrier at the point of care.
The implementation of care pathways that align with value-based care initiatives and alternative payment models can be a valuable tool in ensuring compliance with individual payer agreements and may aid in the success of these types of reimbursement models. Payers may have their own care pathways, or clinical pathways, that they use to manage cost and ensure appropriate care administration. However, when multiple payers require their own pathway programs, with differing reimbursement models for drugs, the complexity of operationalizing in the oncology practice increases significantly.
Determining what defines success and what outcomes should be measured after implementation of oncology clinical pathways can vary greatly by the goals and needs of each individual organization. Internally developed care pathways in community oncology provider groups can be used to align prescribing drugs and regimens that provide the best clinical care to the patients, maximize profitability to the practice or organization, and improve quality of care. However, provider buy-in and support are essential for a care pathway program to be successful in any organization. Continuously increasing administrative burden of managing patients’ care can lead to provider burnout and negatively influence pathway uptake. As alluded to above, ideal pathway programs provide real-time patient care management recommendations and decision tools and are easily integrated into multiple EHRs and the providers’ daily workflow.
While oncology care pathways can provide more standardized care, there may be gaps in treating patients with advanced disease states, where innovative treatment interventions are needed. Manufacturers can support development of clinical pathways by
- Working with organizations that use and develop care pathways to ensure that drugs on the market are included and favorably positioned into clinical pathways and that drugs in development are considered for future inclusion into clinical pathways.
- Maintaining a deep understanding of how their drugs fit into payer clinical pathways and how that may affect market access. When possible, manufacturers can collaborate with payers to develop pathways that are based on the latest scientific evidence and clinical insights.
- Creating and providing educational resources that can be used by physicians and patients to help them understand the clinical benefits of their products and how they fit into the various care pathway platforms.
- Understanding product placement in the EHR at the organization and providing support tools for improved integration between care pathways and treatment plans or order sets.
In conclusion, no matter which type of care pathways organizations and payers are utilizing, these care pathways can be a powerful tool to ensure patients receive standardized, high-quality, evidence-based, and cost-effective care.