Amid the recent political changes in the United States, there has been plentiful discussion about what the future of health care will look like. Certain policies brought about as a result of the Patient Protection and Affordable Care Act of 2010 are predicted to be rolled back, with other initiatives favored by Republicans are ex- pected to be ushered in. Still, many anticipate that the current trend toward making care more value-based will continue unabated.
Scott Guerin, PhD, and Richard G Stefanacci, DO, MGH, MBA, AGSF, CMD, predict that it is simply the approach to improving value that is likely to change, in that there will be a greater focus on the consumer—that is, the patient (page 37). A consumer-driven clinical pathway, they argue, is one that contains a high degree of patient centricity, appealing to patients and caregivers by providing greater transpar- ency around care decision-making and therapeutic selection, and managing intra- provider care coordination more effectively.
On the other hand, according to Cynthia Terrano, CPA, and Karen K Fields, MD, clinical pathways should address the whole continuum of cancer care to make the health system more accountable and become truly patient-centered (page 39). Im- proving overall cost-effectiveness, avoiding redundancies and inappropriate care, and improving care quality should be the goals of pathways in a consumer-driven health care environment.
As the health system evolves in a direction that caters more to patients’ defini- tions of value, it will become increasingly important to incorporate patient-reported outcome (PRO) measurements into research and clinical practice. Currently, there is wide variability in PRO measurement practices, presenting a dilemma to health care providers looking to embrace this shift. RahmaWarsame, MD, and Michele Y Halyard, MD, share their experiences with implementing PRO collection and discuss the key considerations for success, including appropriate measure selection, achieving buy-in from health care providers, and utilizing PRO data in clinical practice (page 43).
Although the shift from fee-for-service to value-based payment systems is likely to continue, new policies are likely to mean patients will have greater decision-making au- thority—but also greater interest in the cost of care, due to increased out-of-pocket ex- penses. Clinical pathways catering to this new environment will not only allow patients to better understand their treatment options, and the associated out-of-pocket costs, but also the impact of care choices on quality of life and other patient-centered outcomes.
