January 2019
What Do We Mean When We Talk About “Clinical Pathways”?
For those new to the world of clinical pathways, the jargon, development process, and ramifications of pathways can seem mysterious and obscure. To put clinical pathways into context, many disease or medical treatment categories use order sets or treatment protocols to define the testing and procedures that constitute the best practice or state of the art for a particular situation. Such order sets collate care standards to increase efficiency of care. Clinical pathways are much more complex and sophisticated than order sets or triage protocols but the goals are similar. This column will provide an overview of clinical pathways as they exist today and attempt to demystify the language, process, and expectations surrounding their development and use…
March 2019
First Things First: Deciding Why Your Practice Is Implementing Pathways
To an outside observer, a cancer center’s decision to deploy clinical pathways might seem counterintuitive: it can be costly, may negatively impact workflow, and doctors notoriously dislike feeling like they are being told what to do. Yet, regardless of these hurdles, more and more cancer centers are opting to implement clinical pathways for cancer treatment. The decision is sometimes prompted by a payer contract, the need to ensure a single standard of care across multiple sites following a merger or acquisition, or as a response to a competitor who has recently deployed pathways. Some practices will simply stop there and be satisfied with implementing a new pathways tool for the single purpose that initially drives the decision. However, when oncology practices view pathways as a strategic asset, they often realize their significant value instead of just seeing them as an annoyance or only as a cost…
April 2019
How Clinical Pathways Can Support Cancer Center Growth, Care Quality, and Cost Containment
Implementing clinical pathways in a cancer center is a large undertaking with multiple implications that ripple throughout the organization. The cancer centers that have the most success start with a strong strategic underpinning; they and their staff fully understand the “why” of implementing pathways. In prior articles in this series, we have explored what clinical pathways are, as well as an overview of the strategies most commonly deployed by cancer centers in implementing pathways. The strategic landscape for most cancer centers will typically include 4 to 6 concurrent initiatives, likely linked to growth, quality improvement, cost containment, and/or workforce well-being. This article will dig more deeply into how pathways can support the most common business strategies for: (1) cancer center growth and care quality and (2) cost containment…
May 2019
Achieving Organizational Culture Change in Your Practice to Support an Effective Pathways Program
Over the last 5 years, many oncology practices have adopted clinical pathways, often with mixed results. The same product may be implemented in different practices and see much lower adoption and utilization rates, or low adherence to the recommended treatments. For instance, through my experiences, I have even heard of clinicians using pathways to record the on-pathways recommendation, then ordering what they believe to be the “right” treatment despite it not being the recommended standard of care, so as not to incur the “off-pathway” mark on their record. Effectively implementing a pathways program can be more challenging than one might initially believe. If a practice goes into the project simply thinking it is an IT implementation, they will be disappointed. Implementing a pathways system and making it an effective part of the practice’s daily efforts for success are two very different approaches. Although the pathways implementation has numerous technical components, the clinical and operational components are among the most important…
September 2019
Engaging Clinicians as Partners in Pathways Utilization
Getting physicians and other clinicians engaged in the use of pathways is not always easy, but it is always essential. Without engaged users of the pathways, the goals of the cancer center in implementing pathways simply cannot be met. The pathways system is a tool—and a tool unused is really of little or no use at all. Achieving clinician compliance with the organization’s standards of use requires a number of aligned factors. More than articulating the expected schedule for pathways use and offering training on the mechanics of the software interface, clinician engagement requires buy-in, governance, and organizational alignment…
January 2020
Recognizing the Limitations Surrounding Clinical Pathways to Ensure Appropriate Use
Oncology clinical pathways are used by thousands of oncologists to select treatments for hundreds of thousands of patients every year. Oncologists may access pathways from a variety of sources, including practice-focused vendors such as Elsevier, McKesson, and Flatiron; vendors contracted by payers such as New Century Health, Oncology Analytics, and Eviti; or even created by a cancer center for their own use. Pathways have helped reduce unnecessary variations in care, helped countless patients receive the latest in lifesaving cancer treatments, and facilitated the enrollment of thousands of patients in clinical trials. Arguably, oncology clinical pathways are one of the single most important tools clinicians have in treating cancer patients. However, with all of those benefits and advances, all pathways systems share certain limitations.
October 2019
Contemplating the Future of Oncology Pathways
Pathways have come a long way since 2004 when initial forays into pathway development were paper-based and offered limited guidance outside of breast, lung, and colorectal cancers. The tools available at that time lacked the subtlety and nuance that current pathways offer. Development of additional disease coverage emerged rapidly, and automated tools emerged in 2007/2008. By about 2015/2016, some tools—such as Via Pathways, Moffitt Pathways, and McKesson’s Clear Value Plus tool—incorporated treatment recommendations for more than 90% of cancer by disease incidence. Payers began to recognize that pathways offered a measure of quality, which helped drive adoption and the growth of payer- and provider-initiated pathways. US Oncology’s Innovent Oncology, the Michigan Medical Home Demonstration Project, and Aetna’s New Jersey pathways pilot all featured the use of evidence-based medicine as a condition for participation…