A Look Into the Future: What’s Next for Pathways?

Health care delivery is always in flux, but treatment advances over the last several years have introduced new variables into the health care continuum that were unthinkable even a decade ago. Researchers, providers, and payers have also striven to ensure that existing therapies are prescribed in both the most medically efficacious and cost-effective manner. The current issue of Journal of Clinical Pathways addresses how established and emerging therapies fit into the clinical pathways model. 

Jeremy Schafer, PharmD, MBA, addresses the role payers can play in antimicrobial steardship (page 27). Antibiotic overuse plagues the health care system. Approximately 47 million unnecessary antibiotic prescriptions are written each year. Appropriate antibiotic use can be hindered by programs requiring patients to pay high cash prices while claims wait to be approved. Clinical pathways may serve to both curb inappropriate use and ease the financial burden some patients face.

Pathways are at their most successful when they address all aspects of the Triple Aim: improving patient experience, recognizing the necessity of population health, and lowering health care costs. Richard G Stefanacci, DO, MGH, MBA, AGSF, CMD, and Terri L Schieder, RN, MS, MBA, argue that many existing pathway programs privilege population health above the other elements (page 29). The authors address how future pathway programs can be revised to look beyond one-size-fits-all models of treatment to better advance both individual patient and global population health, while simultaneously promoting affordable care.

Amy Schroeder, RPh, a senior consultant with the health care consulting firm DK Pierce & Associates, Inc , offers a thorough analysis of how pathway programs are currently being utilized throughout the US health care system, and evaluates their evolution over the observation period (page 33). This report is likely the first of many, as clinical pathway programs continue to grow and change.

Few new therapeutic approaches have generated as many headlines—or as much hope—as immunotherapy. These therapies, which harness the body’s immune system to fight diseases, have improved the quality of care for patients with diseases once thought incurable. Chimeric antigen receptor T cell (CAR-T) therapy is viewed as the next frontier within immunotherapy. CAR-T therapy has shown remarkable efficacy in clinical trials for patients with various hematologic malignancies, and products are expected to begin receiving US Food and Drug Administration approvals as early as this year. Chadi Nabhan, MD, MBA, FACP, and colleagues consider how CAR-T therapies will be integrated into clinical pathway programs postapproval (page 41).

Pathways are not static. The articles herein demonstrate that value-based medical care must remain on the cutting-edge of medicine in order to best serve patients.