As the health care system collectively progresses toward full adoption of the Medicare Access and CHIP reauthorization Act, providers, practices, and health systems have been working to understand the full impact of these changes and to optimize care and care processes to navigate the shifting landscape successfully.
Clinical pathways will play an increasingly larger role in the move to value-base care. To understand the various dimensions of this role, providers should note how market influence is shifting among the key stakeholders. The columns included in this first issue of Journal of Clinical Pathways (JCP) for 2018 set the stage for this conversation in terms of how regulatory changes are affecting and will affect marketplace dynamics in relation to costs and the growing and waning influence of various stakeholders.
In the Pharma Insights column, Ashwin Athri, MBA, examines the growing influence health systems have on local market care delivery (page 39). Follows similar lines of thought in his column, Richard G Stefanacci, DO, MGH, MBA, AGSF, CMD, asks, “Who really controls treatment selection,” and answers the question by examining the complex array of priorities that stakeholders—including payers, patients, prescribers, health systems, and specialty pharmacy providers—have when it comes to treatment selection (page 47). Understanding their positions and treatment goals will enable the creation of clinical pathways that drive stakeholders to the best treatments that achieve their objectives.
The two features included in this issue continue the conversation of how providers are responding to market shifts and the practical role of clinical pathways. The research report by Casey Mason and colleagues examines whether clinical pathway use may be contributing to increased numbers of orders for biomarker testing in patients with non-small cell lung cancer (page 49). In the 7 cancer programs assessed in the article, authors also investigated how patterns of biomarker testing may have influenced subsequent first-line targeted therapy in these patients.
The second feature article discusses a live clinical pathway development simulation that was conducted at the 2017 Clinical Pathways Congress in Washington, DC. For this mock clinical pathway for metastatic breast cancer, authors Bruce A Feinberg, DO, and Chadi Nabhan, MD, MBA, FACP, provide an overview of the pathway development process, including selection of a steering committee and the establishment of discussion ground rules. Authors also discuss how panelists reached consensus within treatment selection parameters, pathway adherence concerns, and how guidelines were integrated into pathways in light of various treatment-related selection factors such as adverse events (page 56).
Collectively, this issue of JCP presents how market dynamics are changing in relation to oncology practices, what providers are doing to evolve with these changes, and how clinical pathways are advancing these changes to achieve better care for patients.
