Balancing Cost, Efficiency, and Clinical Judgment In Advancing Value-Based Care

In our previous Journal of Clinical Pathways issue, I introduced the new tagline, “Advancing Value-Based Care,” to reflect the continuing need to balance cost and clinical perspectives in health care to deliver the best patient care. As I noted, clinical pathways have a role in con­trolling costs and optimizing outcomes. However, I questioned whether using clinical path­ways or treatment protocols allowed physicians to avoid utilizing clinical judgment to make treatment decisions. Treatment protocols, or clinical pathways, are already being utilized in many other clinical settings to deliver timely and high-quality care. However, the missed opportunity to consider other concurrent treatments, clinical presentation, environmental factors, and patient response is where the dependency on the protocols falls short. Thus, value-based care must balance clinical pathways, outline cost-effective treatment options, and include sound clinical assessment and judgment when developing treatment plans.

In this issue, we are taking a deeper dive into our health care system today and review­ing tools, pathway strategies, and outcomes to help our efforts to promote true value-based care. In one of our Research Reports feature articles (page 21), Holmes et al address the time between diagnosis and treatment and how using a clinical pathway can help make the diagnosis to a treatment period more efficient. The authors note the importance of rap­id access to high-quality health care in trauma, neurology, and cardiovascular medicine, eloquently referred to as the “golden hour.” Given that there is a definitive link between significantly reduced cancer survival and cancer treatment delay, there is a strong rationale for expanding the golden hour metaphor to include cancer care to develop diagnosis-specific policies, procedures, benchmarks, regulations, and enforcement mechanisms that promote timely initiation of cancer care. More timely diagnosis and treatment should lead to reduc­ing health care costs resulting from treating a reduced number of more advanced cancers.

To demonstrate the various tools providers can leverage when implementing path­ways, our From the Field feature article (page 32) underscores the need to integrate clini­cal guidance into workflows to improve adherence to evidence-based pathways. In the face of escalating complexity in cancer care, medical oncologists and their patients need cost-effective and intuitive technological solutions that increase efficiency. Successful clinical pathway implementation can be achieved by providers when the pathway is inte­grated into a Clinical Decision Support (CDS) tool within the electronic medical record (EMR). The authors demonstrate that pathway adherence increases by integrating the pathway treatment regimens into the EMR, leading to high-quality, value-based cancer care delivery. The authors note that this is just the starting point, and the next step would be to understand the oncology decision-making process at the point of care, including the impact of prompting clinicians of on-pathway options after an off-pathway treatment has been selected, bringing us back to the balance of clinical pathway options and sound clinical judgment. However, for now, clinical pathways, seamlessly embedded into clini­cal workflows, empower clinicians with timely updates and financial insights, facilitating optimal treatment decisions and enabling organizations to benchmark against industry standards for high-quality, value-based care.

The Journal of Clinical Pathways is always open to receiving your submissions highlight­ing your work and research in the space throughout the year. Manuscripts can be submit­ted at www.editorialmanager.com/jclinpath.