Oncology Clinical Pathways Benchmarking Survey 2021 Results
In the opening session of the 6th annual Oncology Clinical Pathways Congress, Winston Wong, PharmD, editor-in-chief of the Journal of Clinical Pathways (JCP), presented findings from the 2021 Oncology Clinical Pathways Benchmarking Survey. This is 4th year JCP has conducted this survey, which gathers insights from real-world pathways stakeholders to reveal the current landscape of clinical pathways use in oncology practice
“The rationale for the survey is simple, clinical pathways are continuing to become an integral part of oncology care as we transition towards alternative care models and the focus on value-based care,” said Dr Wong.
“The call for accountable care focused on improving clinical outcomes and patient satisfaction, while controlling costs is being renewed along with the addition of greater support for providers,” he continued.
The 2021 Benchmarking Survey had a record-breaking 871 respondents, which was three times higher than those seen last year. Of these 871 respondents, 92% were direct care providers, such as oncologists, pharmacists, physician assistants/nurse practitioners, nurse navigators, and non-oncology physicians. Overall, 67% of respondents were from community practices and 33% from institutional settings.
When comparing payment model participation, traditional fee-for-service (FFS) is down from 65% in 2020 to 32% in 2021. This decrease in FFS participation is balanced by increases in pay-for-performance and full financial risk models of 48% and 21%, respectively in 2021, compared to 37% and 16% in 2020. In addition, partial financial risk increased from 19% in 2020 to 25% in 2021.
“These results confirm the continued movement towards performance-based value-based financial arrangements,” said Dr Wong.
Results from the survey show a renewed interest in pathway implementation with a significant increase in those planning to implement pathway programs in the future. Those planning to implement pathway programs within 12 months increased from 7% in 2020 to 14% in 2021. Those planning to implement pathway programs in >12 months increased from 4% in 2020 to 14% in 2021.
Payers remain a driver of clinical pathways implementation, which is mainly tied to reimbursement. While still rated as a somewhat important driver, the percentage increase from 41% in 2020 to 47% in 2021 is consistent with payers moving toward a more performance-based reimbursement model.
Alternative financial reimbursement models as drivers for clinical pathways implementation increased from 37% in 2020 to almost 50% in 2021. In addition, consistent with continued industry consolidation, parent organization requests nearly doubled from 24% in 2020 to 45% in 2021.
For those who are actively engaging in pathway programs, survey results noted a decrease in pathways being based on NCCN guidelines or other recognized compendia indicating a more restrictive approach to pathway development. Pathway programs seem to be moving toward third-party vendors or adopting the pathway in place in the parent organization.
Overall, oncology clinical pathways appear to be developing more clinical comprehensiveness. The 2021 survey noted increases in surgical oncology and radiation oncology, likely within larger, multisite practices. Supportive care and genomic profiling responses were similar to those seen in 2020.
“The genomic profiling inclusion, specifically the predictive testing, is interesting as we are in an age of personalized medicine where so many of the new targeted and novel medications are being approved of companion diagnostic testing requirements,” stated Dr Wong.
Another noteworthy finding is that 89% of respondents reported utilization of pathways to track individual prescribing patterns compared to 78% in 2020, increasing levels of accountability. Of those tracking prescribing patterns, 75% cannot prescribe off-pathway without peer review for approval, compared with 51% in 2020, and 9% are not allowed to prescribe off-pathway, similar to findings from 2020. In addition, 17% allow off-pathway prescribing with no peer review, down from 32% in 2020.
Respondents reported that consistency with the pathway is encouraged through incentives, financial penalty, and internal reporting.
Standardizing treatment decisions, improving quality of care, improving outcomes, and controlling costs remain the top perceptive benefits of a clinical pathway program. Providers felt there was an importance to pathways assisting to improve satisfaction of their role, as well as representing the mitigation factor to provider burnout. This is consistent with the findings of the JCP Care Pathways Working Group, which will be presented during the Oncology Clinical Pathways Congress on October 3,2021.
Finally, the survey noted that although the implementation of a pathway program can cause major practice workflow burden initially, especially if the program is payer-driven, it is felt that the benefits of the program will balance out the additional administrative burden.
When looking at the impact of COVID-19 on clinical practice, 91% of respondents indicated COVID-19 has caused modification of the pathway program.
When compared to 2020, implementation of telehealth services appears to have decreased, possibly due to services having already been implemented. Telehealth services continue to be utilized and will most likely continue as the pandemic subsides.
In conclusion, survey results indicate an increased interest in clinical pathways, though it is not known whether this is due to increased accountability or a requirement to implement because of an acquisition by a health system. FFS reimbursement is decreasing, balanced by an increase in performance-based reimbursement and risk-bearing arrangements.
Clinical pathways are still based on efficacy and tolerability. Though there is a growing focus on patient preferences and social determinants of health, these factors are likely not built into the clinical pathway decision tree.
Lastly, there is still a perception that clinical pathways can improve the quality of care and outcomes, control costs, and utilization of pathway programs will increase in the future.
Full survey results will be published in Journal of Clinical Pathways. Stay tuned!
