Journal of Clinical Pathways spoke with Robin Zon, MD, FACP, FASCO, chair of the ASCO Clinical Pathways Task Force, about the current state of pathways, the future state of pathways in oncology care, and pathways moving forward into other disease settings.
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What inspired you to work predominantly with clinical pathways?
My interest dates back to a few years ago when I came to appreciate that pathways were being increasingly utilized as care management tools. As time progressed, and as an American Society of Clinical Oncology (ASCO) leader on the Clinical Practice Committee, I was hearing about concerns regarding pathways from our members. As a result of these issues raised to the ASCO Board of Directors, the Task Force was formed and I was honored to be asked to Chair the Task Force in January 2015. Since then the Task Force has diligently worked towards understanding the landscape of pathways, developed recommendations to address concerns noted, published criteria for high quality pathways in oncology, and are now examining various pathway vendor products.
How have clinical pathways impacted oncology care and set the trajectory for oncology care for years to come?
As utilization management tools initially focused on drugs, pathways have shown to reduce variation of care within a group as well as control costs. In some cases, cost reduction has also been proven. Beyond drug utilization, pathways have also been used in triage and there is published data regarding improved quality of care as well as reduction in avoidable emergency room visits and hospitalizations as a result. These are examples of how pathways are being implemented in clinical practice and what impact they have had thus far. Additionally, there is data from ASCO’s State of Cancer Care report demonstrating increasing uptake of pathways in practice (other sources such as a Genentech report in 2016 confirm the same). Keeping these points in mind, and then considering the motivation of payers to control costs while improving quality of care, along with the National Statute (Medicare Access and CHIP Reauthorization Act and the Quality Performance Payment System) transition to a value based care delivery system is approaching. Even beyond the value aspect in terms of quality and finances, pathways may serve as a valuable tool in the transition to a value-based system of care and may also serve as potential leverage in policy regarding delivery reform. Lastly, pathways can also assist providers in managing the rapid growth of knowledge for all cancers, especially with incorporation of the molecular basis and immunogenic basis for interventions.
What is another disease state that you believe to be most adaptable to clinical pathways?
Pathways are certainly prominent in the medical oncology field, but I suspect they could be developed for other medical specialties, such as radiation oncology, gastroenterology, general internal medicine, emergency medicine, rheumatology, family medicine, and the field of genetics with risk assignment and appropriate screenings. However, I suspect pathways could be developed for a number of other specialties as well, and ultimately few disease states or areas of medicine would not be included.
What purpose do you believe value-based care serves in health care reform?
I interpret value-based care as delivering the right intervention, at the right time, to the right patent regardless of site of service and geography. The value aspect implies that there is maximization of quality care linked to most efficient resource use, thereby optimizing resources and the heath care dollar. The purpose of value-based care in health care reform centers around these notions, and moves care away from being volume based to value based with a goal of optimizing quality in context of resource utilization.
What are some areas that pathway vendors and programs can improve upon?
I suggest an increase in analysis of outcomes in term of patent-reported outcomes and survival, as well as an increase financial analysis surrounding costs to patients and the health care system realized by a particular pathway program. Furthermore, pathways certainly have a potential role in alternative payment models, such as in the ASCO Patient Centered Oncology Payment Model (PTOC) soon to be submitted to the Physician Technical Advisory Committee (PTAC).
