Journal of Clinical Pathways spoke with Winston Wong, PharmD, editor-in-chief about the role of clinical pathways and value-based care in health care reform.
What inspired you to go into your field?
I wanted to be in the medical field and to help sick patients. My options were pharmacy, nursing, or becoming a physician. I wasn’t social enough to be a nurse, and I didn’t want to deal with all of the responsibilities nurses have. Physicians are relatively well paid, but the schooling required was long and expensive—and frankly, I wasn’t smart enough. So the option I had left was pharmacy. At the time, pharmacy was an evolving sector of health care, and I luckily had influential mentors that helped me see the future. The rest is history.
What do you believe the role of clinical pathways will be in health care going forward?
Clinical pathways will be an integral part of health care as we move forward, especially if pathways move away from being just treatment regiments and become more comprehensive care plans. Care will become less variable and more cost efficient. Because follow-up will be incorporated into pathways, patients will be followed more closely, minimizing ineffective treatment. This will lead to patients achieving clinical goals more rapidly. I believe clinical pathway uptake will be greater in the provider arena, as the provider organizations are taking on more risk for care. Therefore, pathways are a means to help clinicians provide more consistent care. Measuring outcomes is the only missing link to show true cost effectiveness.
How do you see value-based care being addresses as health care reform continues to evolve?
I believe that value-based care will be a central focus of health care reform. We have to be careful that we do not overmanage the process so that the care provided is a one-dimensional model of profit margins, as we started to see back in the 1980s. The integration of clinical performance measure should help mitigate this concern. But for true value-based care to be successful, we need to keep the goals of the “Triple Aim” as the basis of our value-based evaluations. We must keep the patient at the center of focus, while providing quality care at an affordable cost. Value-based care and health care reform go hand in hand.
How do you see bundled payment models, or other alternative payment models, improving patient access to quality care?
Bundled payments, or other types of alternative payment models, holds the provider organization accountable to provide quality care. Anything less than quality care will result in additional resources being used to care for the patient, thus representing additional costs going against the cap. This includes patient monitoring and follow-up, in addition to a proactive approach to maintain wellness and prevent unexpected events. The bottom line is that greater access to quality care will be required to avoid additional unexpected costs.
What medical specialty other than oncology do you believe is most adaptable to clinical pathways?
Clinical pathways can be applied to any medical specialty that requires treatment options and supportive care. Any chronic condition where guidelines have been created by professional organizations based upon peer-reviewed data can be transitioned into a pathway. Keep in mind that the main difference between a guideline and a pathway is accountability. Guidelines are consensus statements provided as recommendations. Pathway treatment options are usually a subset of the guidelines, and hold a degree of clinical and financial accountability. In short, as a starting point, any condition with a set of published guidelines can be easily translated to a pathway; other conditions with no guidelines published will take a little more effort, but it can be done. The most applicable conditions are those for which guidelines have been published, but where variation between the guidelines and the actual care that patients receive continues to persist.
