The adoption of clinical pathways is helping to standardize the cancer care process, with adherence to established protocols impacting efficacy, safety, and overall cost of care. There has been a tremendous growth in the use of oncology clinical pathways by providers and payers. The American Society of Clinical Oncology (ASCO) State of Cancer Care in America 2017 report documented a 42% increase from 2014 to 2016 in practices reporting compliance with a pathway program.1,2 Many large payers are also partnering with oncology providers and pathway companies to implement oncology pathways as a means of reducing variation and controlling costs.3
As with any innovative and emerging tool or care model, how to design and make the best use of clinical pathways is a persistent question with evolving answers and approaches. Each facility and cancer center is different in terms of location, setting, infrastructure, size, resources, staff, and leadership. One way to advance knowledge and improve the use of clinical pathways is to talk with and learn from the pioneers and leading institutions in the field who have gained success developing and/or using clinical pathways.
This article is the first installment in a new Journal of Clinical Pathways series called “Cancer Center Spotlight,” which brings readers inside pathways programs at top cancer centers around the United States. In this series, we will profile cancer center clinical pathways teams and leaders to gain a better understanding of why they use clinical pathways in their facilities; how their infrastructure and staff support pathways use; how the data captured by pathways is utilized for reporting and measurement; and how their pathways are evolving.
The first cancer center visited was the Moffitt Cancer Center, Tampa, FL, where we conversed with the cancer center and pathways program leaders and specialists on the clinical pathways development team. We also spoke with individuals in their payer strategies department about how they leverage the pathways program to enhance reimbursement models. These conversations gave us a comprehensive view of how Moffitt designs, implements, uses, and perpetually revises their clinical pathways and the role their pathways play in care delivery, reimbursement, and overall institutional mission.
Getting to Know the Moffitt Cancer Center
Moffitt houses Florida’s largest clinical cancer research unit, currently conducting more than 450 clinical trials and nationally ranked as the 8th best cancer hospital by US News & World Report.4,5 The Cancer Center is currently the only National Cancer Institute (NCI)-designated comprehensive cancer center based in the state. Moffitt is partially publicly funded, as it was established in 1981 and founded in 1986 as the state’s cancer center.4,6 The full spectrum of oncology services is available on the Moffitt campus to treat patients from diagnosis through survivorship. In addition, they ensure that all physician researchers still treat patients to some degree, even those in senior roles like Moffitt Cancer Center President and CEO Alan F List, MD.
Jack Kolosky, CPA, MBA, chief operating officer of Moffitt Cancer Center and president of Moffitt Hospital, noted one of the most distinctive aspects of Moffitt: “From the start, we have been organized into multidisciplinary care teams and departments and that interdisciplinary model enables our people—medical oncologists, surgeons, radiation, radiologists, pathologists, support teams, nursing and social work, etc—to work together easily in clinical teams.”
Mr Kolosky explained that, as a relatively young organization, Moffitt has been able to depart from past methods of other academic centers; their relative youth, in addition to their size, has allowed them to be more nimble in responding to changing affairs and treatments within oncology, including care delivery and reimbursement models. These factors have contributed to their current and future projects, including their Moffitt-created and maintained clinical pathways, work on managed care plans, and innovative contracting efforts.
Mr Kolosky explained: “I would say that our outcomes are superior, in part, because of our clinical interdisciplinary team model. But it is also due to the proficiency of our faculty in general and how we have developed and utilized tools like clinical pathways to focus our treatment plans on the best available evidence to produce the best outcomes.” He also emphasized that “the heart and soul of what Moffitt does is research.” Because of this, Moffitt takes special care to integrate all available clinical trials into the specific pathways to which they are relevant—constantly updating the pathways with the clinical trial options as needed (Read the full interview with Mr Kolosky).
Jeremy Drainville, MBA, director of clinical pathways at Moffitt, said, “There’s a unity among the leadership about the overall direction of our strategic plans, and we work actively together as a team to support those plans.”
To gain a more complete understanding of the steps and processes necessary to create and update their clinical pathways, we spoke at length with the program leaders, Mr Drainville and Karen K Fields, MD, senior member, medical oncology, and medical director, Clinical Pathways and Value-Based Cancer Care.