Where Do Clinical Pathways Go From Here?

As we bring a close to 2016, the first full year of publication of Journal of Clinical Pathways (JCP), it is a good opportunity to reflect on how the role of clinical pathways in the health care landscape has grown and evolved.

Over the last year, health plans and provider groups have continued to implement clinical pathways to improve the cost-effectiveness of cancer care. According to the American Society of Clinical Oncology (ASCO), an estimated 60 individual health insurance plans in the United States are currently using or developing oncology-specific pathways, and in 2010, approximately 15% of oncology “covered lives” were treated according to clinical pathways—a number which was expected to rise to 25% in 2015. A recent Deloitte report found that roughly 50% of patients are currently being treated in accordance with evidence-based medicine.

As the popularity of clinical pathways continues to grow, there will be a need for greater consideration of how pathways are being developed, implemented, and evaluated.  ASCO has recognized this fact and began the year by releasing a Policy Statement on Clinical Pathways in Oncology.  After identifying concerns about current clinical pathway programs, the ASCO Clinical Pathways Task Force developed 15 Criteria for High-Quality Clinical Pathways in Oncology, which were released this past month. ASCO hopes that these criteria will “help oncology providers and other stakeholders better evaluate clinical pathways and ensure that pathways are developed and implemented in the way they are intended and promote the desired outcomes.”

As we move forward with integrating clinical pathways into health care, we also will need to rethink how health care is being delivered. Value-based care initiatives from the Centers of Medicare and Medicaid Services (CMS) have led the way in this area. One example is the development of the CMS Five-Star Quality Rating System. Maureen Hennessy, PhD, CPCC, and Larry Blandford, PharmD, discuss how this initiative will lead to improvements in the quality of care (page 29).  A greater focus on patient-centered care is also needed. Ned L  Woody argues for the need to rethink the concept of “delivering” care in order to encourage patients to take a more active role in their treatment (page 39).

Finally, we must continue to explore ways to apply the clinical pathways concept to other treatment areas. In this issue, Richard G Stefanacci, DO, MGH, MBA, AGSF, CMD, and colleagues discuss how pathways can guide the treatment of multiple sclerosis (page 33). As a supplement to this issue of JCP, we examine the application of the clinical pathways concept to diabetes in a Special Issue of the journal.

In the coming year, we will strive to continue to publish research and insights in this area in order to guide efforts to help stakeholders navigate the pathway environment and enable them to maximize the value of pathways to patients.