How Pathways Can Aid in Managing Patient Cost of Care

In this interview, Chevon Rariy, MD, Oncology Care Partners, discusses how clinical pathways can help in providing personalized treatment to patients and managing patient cost of care. She spoke at the 2023 Clinical Pathways Congress + Cancer Care Business Exchange as part of a panel discussion titled “The Evolving Role of Cost in Pathways: Cost of Care, Cost Avoidance, and Patient Costs.”

Transcript:

Chevon Rariy: I'm Chevon Rariy. I'm the chief health officer of Oncology Care Partners, where we are an innovative value-based oncology care company that focuses on leveraging innovative technology to improve the patient experience, improve patient outcomes, and really bend the cost curve.

How does cost factor into pathways, both from a payer and the provider perspective?

Dr Rariy: For the pathway development cost factors in, I would say, very low level. We look at first from the payer perspective, efficacy, toxicity, and then only cost. From the provider's perspective, cost is a factor really from the perspective of the patient. So understanding the financial implications that various treatments might have for the patient is first and foremost. From the provider perspective, it's rare that various different incentive plans come into play when deciding what's the best treatment option for the patient, it's not top of mind. What's really top of mind is looking at how we can personalize the care for the patient, how we can deliver the care in a timely fashion and intervene appropriately. And again, what's best for the patient based on their financial situation and understanding various copays and financial assistance programs that are available.

Can you talk about the need for balance between standardization of care and the need to personalize treatment for each patient?

Dr Rariy: So in terms of needing to balance standardization with personalized care, I think we can understand that practicing evidence-based medicine based on the NCCN guidelines and making sure that we have pathways that adhere to that is of utmost importance. We want to make sure that across the board no matter where you're receiving your care, you're receiving the highest quality of care that has the most evidence to back up how we deliver that care.

Now when we look at personalized medicine, we want to make sure we're speaking about when we are able to determine based on the patient's genetic profile, as an example, their molecular studies, that we are able to provide targeted or precision medicine-based treatment for patients in a timely manner. To make sure that we are providing them with the appropriate care upfront that can best improve their disease survival.

How does a robust technology infrastructure assist clinicians with decision support?

Dr Rariy: As you can see, to be able to truly, I think, realize the value of value-based care we do need a robust technology infrastructure and clinicians need to be a part of that robust technology infrastructure. And it needs to work in coordination with the clinical workflow, not deter clinicians from practicing care. And so in that way, the clinical decision support tools that are almost super powering that clinician's ability to mine a significant amount of data and to provide those insights at the point of care is truly I think an opportunity for both the health care field to leverage IT and create a deep infrastructure there and to improve the practice of medicine at the point of care.

Why is it important to look at the individual needs of each patient, including their background and their specific circumstances, when deciding the course of treatments?

Dr Rariy: So I think we can all appreciate that there are several barriers that can impact care regardless of socioeconomic status that need to be taken into account when we are looking at what's the best treatment regimen for a patient and how can that be executed. And so that absolutely needs to include the social issues that patients may confront, whether that is the ability to have appropriate transportation to their appointments or whether or not they have adequate nutrition to be able to make sure that they are able to tolerate different types of foods, depending on the regimen that could be exacerbated. And all the way to looking at other areas like mental health and various components from a social standpoint. Making sure that they have a caregiver who can help manage the various issues that arise when patients are moving through their care journey within the cancer space. All of those need to be taken into consideration.

And again, it spans many different backgrounds, many different language groups. And so it really is important to take that holistic approach to patients to improve their success in managing their cancer and will benefit their survival.

Is there anything you'd like to expand on that you weren't able to cover in your session?

Dr Rariy: I think one of the things I wanted to highlight, had a chance to highlight just a little bit, is the opportunity when we're looking at clinical pathways, it's all fundamental to the data. And the data that we can obtain really rests on ensuring that the data is representative and making sure that as a diverse population is what we're treating the cancer for is who is enrolled in the clinical trials. And so I think the onus is on all of us to better understand and perhaps think outside of the box for how we can make sure that we have appropriate representation in the foundation of our pathways, which is the clinical trials.

And so, whether that's leveraging technology to improve access to clinical trials or committing to decentralized clinical trials, integrating communities into large academic medical centers who are conducting those clinical trials and enabling those community centers to be able to do that are things that we can holistically look at and make sure that we are focused on. Because ultimately making sure that we have a full data set will impact the evidence and improve the possibility of us discovering drugs for particular molecular types and really improving the cancer care, cancer treatment, and cancer paradigm for everybody.