The health care sector has undergone a shift in the way care is delivered, in the way outcomes are measured, and in how services are reimbursed. The movement has been toward more data-driven science with an emphasis on high-quality outcomes at less cost.
Payers and providers alike seek to ensure clinical decisions are based foremost on the best and latest evidence across all settings. Most failures in care delivery are due to deficiencies in systems and processes, not in failures of the individuals. If providers can streamline and standardize care, there is the potential to reduce unnecessary variation in care, which saves money and improves outcomes.1
The guidance that comes from clinical pathways encourages widespread and consistent evidence-based practice of medicine by incorporating the most up-to-date clinical guidelines with efficacy and, when appropriate, financial considerations. However, clinical pathways programs can vary greatly, for example, in terms of granularity, platform integration, and goals of the organization implementing them.
Now in its fourth year, the Oncology Clinical Pathways Congress (OCPC) serves as a forum for oncology care professionals interested in utilizing clinical pathways as a tool to facilitate more value-based care delivery in their facilities. For those using pathways or in the early stages of pathway development, experts in clinical pathways will demonstrate how to get the most out of a pathways program. Discussions center around practical issues such as reducing physician burden; pathways in reimbursement strategies; aggregation of data and use of predictive analytics; and pathways beyond treatment decision support.
Steering committee members include Robin T Zon, MD, FACP, FASCO, chair, American Society of Clinical Oncology, Pathways Task Force; Wui-Jin Koh, MD, senior vice president, chief medical officer, National Comprehensive Cancer Network; and Frederick M Schnell, MD, FACP, chief medical officer, Community Oncology Alliance.
This year’s featured session will be on the Oncology Care Model (OCM), one of the most advanced efforts yet to shift the delivery of health care from a fee-for-service model to a fee-for-value model. With the current 5-year model ending in 2021, this panel discussion will bring together pathways stakeholders experienced in OCM utilization to summarize the strengths and weaknesses of the current model.
Journal of Clinical Pathways (JCP) spoke briefly with a few of the OCPC 2019 presenters to get a sneak peek at what attendees can expect to learn at the Congress.
Integrating Pathways and Guidelines Into EHRs: Improving Outcomes and Value While Reducing Physician Burden
Lalan S Wilfong, MD, vice president, Value Based Care and Quality Programs, Texas Oncology
What are the largest challenges associated with integrating clinical pathways into an
electronic health record (EHR)?
Dr Wilfong: The biggest challenge associated with integrating clinical pathways into an EHR is data integration between the pathways program and the EHR. Ideally, it’s best to minimize any burden placed on the physician. That is to say, the pathways program should electronically pull all clinically relevant data needed for pathways compliance, which includes staging, line of therapy, prior therapies, molecular markers, and performance status. This allows the physician to quickly locate the correct part of the decision tree to facilitate compliance. In return, the pathways should populate the EHR with pathways status and any changes to data that may have occurred during the ordering process. Additionally, the flow from pathways status to actual order entry of a regimen should be seamless.
How does full pathway integration into an EHR have the potential to reduce the burden placed on oncology clinicians?
Dr Wilfong: “Physicians love clicks,” said no one ever. Physicians spend a majority of their time, according to recent studies, documenting details in the EHR. This leads to burnout and poor clinical care as physicians don’t have time to actually spend tending to patients. By fully integrating systems, you can minimize the EHR burden for physicians. Additionally, a well-thought out process helps guide physicians to clinically relevant information that can be used as a tool to support decision-making. For example, it is very difficult to remember all the molecular markers required for non-small cell lung cancer; with advances in care, these change regularly. Well-designed pathways integration gives the physician a resource for evidence-based decision support.
The Oncology Care Model: Current Opinions and Future Perspectives
Tom Valuck, MD, JD, partner, Discern Health
As we near the end of OCM, is the model largely considered by its participants to be a success or flawed?
Dr Valuck: OCM practices are continuing to improve their quality and cost results overall, but only a third of the practices have earned a performance-based payment so far. The Centers for Medicare & Medicaid Services has stated that its goal is to drive providers to advanced alternative payment models (APMs) that require downside financial risk. So, from the policymaker’s point of view, the success of the OCM will primarily be determined by how many of the participants end up taking two-sided risk in the advanced APM arm of the program.
How will the lessons learned from OCM likely shape the future of innovative value-based
payment models?
Dr Valuck: While OCM implementation has shown that we still have challenges with patient attribution, risk adjustment, and data sharing, OCM participants have found ways to leverage technology to improve care coordination and measurement to decrease unnecessary ER visits and hospital admissions. OCM practices’ successes coordinating care will be important to carry through into future models.
The Convergence of Predictive Analytics & Evidence-Based Pathways Under Value-Based Care
Charles Saunders, MD, chief executive officer, Integra Connect
How are predictive analytics being utilized to inform treatment decisions and care management resource allocation?
Dr Saunders: Predictive analytics, coupled with patient risk stratification, can facilitate more targeted and proactive care intervention. By predicting the likelihood of an adverse event, from an avoidable ER visit to chemotoxicity to depression exacerbation, care managers are empowered to not only identify high-risk patients but deliver targeted interventions to address specific event types. In short, predictive analytics enables care teams to deliver the right care, to the right patient, at the right time.
How can predictive analytics, combined with clinical pathways, further improve outcomes?
Dr Saunders: With the rise of novel therapies, oncologists are looking to compare a set of therapies and predict outcomes, including survival rate, potential treatment delays due to unmanaged adverse events, and total cost of care. Based on a patient’s specific diagnosis, stage, and other clinical factors, oncologists can leverage predictive models to project the efficacy, toxicity, and total estimated cost of care for each treatment option. These insights enable oncologists to make more informed treatment decisions in alignment with value-based care objectives.
To view the OCPC agenda and register, click here.
Reference
1. McKinney M. Oncology clinical pathways: the Yale experience. J Clin Pathways. 2019;5(5):29-31. doi:10.25270/jcp.2019.06.00085
