Adopting and Scaling Pathways From the Provider and Payer Perspective

In a session at the 6^th annual Oncology Clinical Pathways Congress, representatives from a health system and a payer organization will present their unique viewpoints on the adoption and scale of oncology clinical pathways.

With various clinical pathways currently in use, it can be challenging for providers and payers to determine which programs are right for their organizations. Factors to consider include rationale and goals for implementation, determining whether to use an outside vendor or develop a program internally, pathway maintenance, reimbursement, administrative burdens, physician buy-in, and more.

Mahek Shah, MD, Harvard Business School and Harvard School of Public Health and Brigham Health, presented from the provider perspective and Jennifer Malin, MD, PhD, UnitedHealth Group, presented from the payer perspective.

In Dr Shah’s portion of the presentation, he focused on trends in pathway adoption and scale, including telehealth, value-based care, and adjustments to treatment; tools used in this process, including centers of excellence and technology; and the future from the perspective of providers and payers.

In summary, providers are seeing more value-based adoption of pathways in oncology care because it can serve as risk mitigation for an already strained health care system. Providers want pathways to evolve into having more flexibility based on new trials, new data, and new studies, that lead to a “smarter” pathway. With the utilization of technology, the hope is that the adoption of and scaling of clinical pathways will be easier.

“Pathways, I think allow us to have and practice top of license, because our job is to really deliver the highest quality care possible,” said Dr Shah.

“COVID has really forced us to reimagine how we do things, how to leverage technology, and how to really leverage these capabilities to adopt and scale pathways going forward,” he concluded.

In Dr Malin’s portion of the presentation, she focused on the role of evidence-based, patient-centric clinical pathways in oncology; the current status, benefits, and impact of pathways in the delivery of high-quality care; future applications, including potential challenges; and the implementation of clinical pathways to optimize the quality of care, cost-efficiency, and health outcomes in oncology.

In summary, payer pathway programs provide a mechanism to implement value-based oncology care at scale. Pathway programs provide additional value beyond traditional prior authorization programs. Payer incentive programs can increase adherence to pathways. Lastly, integration of payer pathway solutions with provider electronic health records to facilitate pathway selection at the point is needed to drive further adoption.