The Value of Educating Employees Regarding Clinical Pathways

J Clin Pathways. 2023;9(6):60-61.

There are two major types of clinical pathways based on the type of organization sponsoring the pathway and control­ling its design: a payer version and a provider version. While both types of pathways use similar criteria, they may offer dif­fering recommendations due to cost.

Many patients hear the words “clinical pathway” and/or “guideline” and their first thought is, “My employer wants to cut my access to different hospitals or providers as well as their cost.” Most employees as consumers perceive that pathways will limit access to care and put more money back into the pocket of the employer.

Because there are limited consumer, patient-oriented educational resources available regarding the value and benefit of clinical pathways and/or guidelines, employees are not aware of their value. Articles and videos written for the consumer at their level are needed so they can clearly see the value for themselves or their family’s care. These resources can help patients understand the purpose of the pathway, how it works, and what they can expect from it. Patients can further understand how pathways should be utilized to help them make informed decisions about their care and treatment. Instead, there are currently many articles written clinically that focus on cutting cost rather than on the benefits pathways can bring to patients and their families.

Clinical guidelines and clinical pathways are both used to guide medical treatment, but they differ in their approach. As a general definition, clinical pathways are evidence-based interdisciplinary plans of care implemented for a group of patients with a specific condition. Care pathways can be much more comprehensive than the tools that most health care organizations have traditionally relied on. For example, they can provide greater depth than the evidence-based guidelines (sometimes called clinical pathways) that have been developed by various professional groups to describe best practices in clinical care. Although these guidelines often offer enormous assistance to clinicians providing treatment to specific patients, they generally include little or no information about costs, optimal settings of care, or supporting services and structures. Thus, they provide only limited insights to health systems looking to define value or reconfigure service delivery.

There are some advocacy groups, such as cancer support organizations, with videos that explain pathways (guidelines) and why pathways are important for patients and their care. Those efforts explain the value of decreased variation in care along with personalization of care if needed. These communications educate the consumer that pathways and guidelines are not one size fits all and, importantly, that the consumer has the right to ask their doctors if they are using a pathway or guideline to treat them. If the answer is yes, they can ask to see it and have the value regarding their personalized care explained to them.

There are also advocacy groups that explain guidelines and pathways as one-size-fits-all methods in which patients with specific conditions are provided the same treatments in order to save money, regardless of individual differences. In addition, videos that are targeted to general or specific consumers are also mixed with videos about pathways software for physicians and hospitals, decision-support software, and/or clinical videos outlining clinical pathways for medical personnel. Such an approach can be confusing for consumers when they attempt to do research on pathways and guidelines because the information is all mixed together. Also, having additional articles explaining how pathways can improve cost saving and outcomes for third-party payers all in one source site is overwhelming and can thereby increase confusion. Staking out a clear perspective starts with effective education.

A more concerted effort by employers to source, create, and distribute effective consumer education regarding clinical pathways and/or guidelines to their employees will help dispel the confusion and misinformation that employee members are finding on the internet and hearing from friends or family. Employers can contact the hospitals and providers in their network and ask them what pathways they are using and obtain the information that is being shared with consumers and their families. Patients can contact the Cancer Support Community, as they have some excellent short videos that are helpful in educating consumers on pathways.

Clinicians have been discussing shared decision-making for years, but in today’s health care environment it is more important than ever. With shared decision-making the provider and the patient can discuss the clinical pathway, then discuss its benefit with the patient and their family. Payers can also educate their care managers to review shared decision-making and clinical pathways with the members so they can have a better understanding before they see their doctor. For example, the National Patient Advocacy Foundation has a current initiative regarding shared decision-making that includes the consumer and their families in the process of care.

It is incumbent on the third party-payers that are used by employers to educate their members regarding the tools they are using for health care in order to obtain improved buy-in and consumption of these services by the consumers/members. An educated consumer/member generally utilizes health care better and is more cost effective than a similar non-educated member. Also, once they have learned the value of clinical pathways/guidelines, they will do an excellent job of spreading the word to other members.

Positively leveraging clinical pathways and creating an educated member is beneficial to employers sponsoring member care programs. Elements that are important for employers and their advisors to communicate effectively include the following.

1. Know what information is out there on the internet so you can prepare a better or more effective value-based story. Some false or misleading examples may be:

• Clinical pathways are one size fits all.
• Clinical pathways are a way to limit care.
• A clinical pathway is just a money-saving operation for the employers and the health care system.
• Clinical pathways are just for patients with cancer.

2. Have firsthand knowledge of what various advocacy groups are saying, good or bad, and how they are saying it. Examples of such groups are listed below.

• National patient access groups
• Community oncology groups
• National patient advocacy entities

3. Help your employees understand the value of clinical pathways when it comes to their personal care. Make it about them and their families instead of just about how it can contain cost, lower copays, or reduce coinsurance requirements. This can be done in the following ways:

• Create a campaign to educate employees about clinical pathways/guidelines and why they are important.
• Address what the difference is between a pathway and a guideline, if applicable.
• Explain to employees who creates pathways and how often are they updated.
• Discuss how a pathway can benefit the employee or their family member, both clinically and financially.

The results of these efforts from providers and employers will be beneficial to all key stakeholders, which includes the member patient of the employer plan.

Reader questions, feedback, and suggestions are always welcome and can be directed to JCPEditors@hmpglobal.com.