In the opening session of the 5th annual Oncology Clinical Pathways Congress, Winston Wong, PharmD, editor-in-chief of the Journal of Clinical Pathways, presented a brief look at results from the Oncology Clinical Pathways Benchmarking Survey. The Survey was been conducted for 3 years by the Journal and gathers insights on real-world pathways prevalence, use, design, impact, and challenges, as well as pathways users’ activities in alternative payment models. Dr Wong said, “We need to understand where we are today to be able to have a vision for tomorrow.”
There were 185 total respondents to the survey: 92% were direct care providers, such as oncologists, pharmacists, nurse navigators, and non-oncology physicians. Almost 70% of respondents were from institutional settings with 26% from community practices.
When comparing 2019 and 2020 responses, almost half of respondents have pathways in places, compared to 66% of respondents last year. And 7% of respondents said they have plans to implement pathways within 12 months, compared to 14% from last year. “We are seeing a plateau in terms of pathway utilization and implementation in the oncology arena,” said Dr Wong.
We are also seeing that payers are a driver of pathway utilization, mainly tied to reimbursement. In addition, providers are becoming a driver for pathways, due to the rapidly evolving research and treatment options, and the inability to keep up with the latest treatment options.
Oncology clinical pathways appear to be slowly developing more comprehensiveness, as responses show a wider representation of service lines and departments. Supportive care was always discussed but is now documented for accountability. Greater appreciation for the nurse navigation may have led to an increase in its inclusion, especially in these times of the pandemic, Dr Wong said.
Another noteworthy finding is that almost 80% of respondents are using pathways to track individual prescribing patterns, increasing levels of accountability. Consistency with the pathways seems to be encouraged through peer review and not financial penalty.
Standardizing treatment decisions, improving quality of care, improving outcomes, and streamlining data collection remain top perceptive benefits of a clinical pathways program. Cost control is a lower driver compared to 2019, possibly due to the shift from fee-for-service reimbursement to overall performance/outcomes-based reimbursement. Usefulness in payer contract discussions serves as a basis for value-based/performance-based reimbursement models.
In summation, Dr Wong concluded that responses confirm the continued consolidation in the oncology arena. Fee-for-service reimbursement continues to be the primary reimbursement model, with continued movement toward performance-based reimbursement, partial/full financial risk models, and bundled payments. Clinical pathways are becoming more comprehensive and not just sequencing medication treatment options with the inclusion of supportive care and nurse navigation. There is still some belief that clinical pathways can improve the quality of care and outcomes, streamline data collections, and control cost.
Full survey data and commentary will be published in an upcoming issue of the Journal of Clinical Pathways.—Amanda Del Signore
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