Moderator Robin Zon, MD, FACP, FASCO, Michiana Hematologu Oncology PC, Chair of the ASCO Clinical Pathways Task Force, started off by providing a brief history of clinical pathways in oncology. Starting in 1985, she said, clinical pathways were developed with the primary goal of improving the efficiency of care. Dr Zon was careful to point out that the goal was not standardization of care, and nor should that be the goal of clinical pathways today.
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In response to ASCO members’ concerns regarding clinical pathway use, former ASCO President Peter Yu established a Clinical Pathways Task Force to investigate the impact of clinical pathways on oncology care providers. The Task Force turned to consultants DK Pierce and Associates in order to gain an understanding of the pathways environment.
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The report showed that oncology clinical pathways have been implemented in nearly all US states, with pathways being operated on the national, state, and local levels. These include collaborations between pathways vendors and payers in all states, vendor-provider collaborations in some states, and independent provider-developed pathways.
With the various pathways programs being implemented, the primary concern that has arisen is that there is currently no system in place to ensure the integrity or quality of pathways.
The report to the ASCO Clinical Pathways Task Force also revealed that providers and patient advocates cited technology as being a key component for ideal clinical pathways. They also asserted that clinical pathways should aim to protect patient and physician autonomy as well as reduce administrative burden.
Based on this feedback, ASCO developed nine recommendations for the development of clinical pathways in oncology; these were published in January 2016 in the American Society of Clinical Oncology Policy Statement on Clinical Pathways in Oncology. Essentially, the recommendations are that clinical pathways: reduce administrative burden; are transparent; address the full spectrum of care; reflect the best evidence; recognize patient variability and autonomy; have the potential to improve administrative efficiency but require some changes in order to do so; promote clinical trial participation; are subject to a certification process; and should have their outcomes evaluated by all stakeholders.
Dr Zon mentioned that ASCO is currently pursuing an accreditation program for clinical pathways but that this will require additional policy work in order to be successful.
At the most recent meeting of the Clinical Pathways Task Force, Dr Zon reported, members reviewed feedback from three groups of stakeholders on clinical pathways: payers, health care providers, and patient advocates. All three groups stated that they support the potential of clinical pathways. They stated that patients currently have very little understanding of pathways but that they are interested in learning more about them, highlighting a need for better education. The stakeholders also suggested that clinical pathways are still too early in development to be evaluated yet for certification.
Dr Zon closed her presentation by addressing the question of why those in the oncology field should care about clinical pathways if they are not currently dealing with them directly. She pointed out that the Centers for Medicare and Medicaid Services Oncology Care Model, the Merit-based Incentive Payment System (MIPS), and other alternative payment models will all tie payment to the quality of care provided. Additionally, each of these programs will require documentation of quality improvement. Pathways, Dr Zon said, are a means of making everyone accountable for the quality, cost, and value of the care provided and have the potential to serve as the cornerstone of demonstrating value for these programs.
