An Inside Look at ASCO’s Evaluation of Pathway Vendors
Oncology clinical pathway use by providers and payers has grown tremendously in recent years. The American Society of Clinical Oncology (ASCO) defines an oncology clinical pathway as a detailed protocol for delivering cancer care, including but not limited to anticancer drug regimens for specific patient populations, such as type, stage, and molecular subtype of disease.
Payers and providers must ensure consistency of evidence-based care, manage drug use, lessen the administrative burden associated with payer appeals, capture stakeholder and molecular data, put pressure on drug prices, and promote accrual to clinical trials in order to assist the growth of oncology clinical pathways. ASCO has taken a few steps to ensure the integrity of oncology clinical pathways and to raise awareness of these products to oncology providers, patients, and other stakeholders. Among these steps were the Pathways Task Force in 2016, which examined the role of pathways in oncology and defined the characteristics of a high-quality pathway; Criteria for High-Quality Clinical Pathways in 2017, which allowed for evaluating pathways based on development, implementation, use, and analytics; and evaluation of national pathway vendors against these Criteria to assist stakeholders in navigating the current pathway landscape.
In the latest edition of the Journal of Oncology Practice (March 2018;14:e194-e200), ASCO published the results of the evaluation process of national pathway vendors against the Criteria for High-Quality Clinical Pathways. Journal of Clinical Pathways spoke with two of the co-authors of the report—Robin T Zon, MD, FACP, FASCO, chair, ASCO Clinical Pathways Task Force, and Bobby Daly, MD, MBA, Memorial Sloan Kettering Cancer Center (New York, NY)—regarding the results of this effort.
What do commercial pathway programs have to gain from being aligned with ASCO’s Criteria for High-Quality Clinical Pathways?
The real question is why were the criteria established? In short, ASCO members had articulated concerns about the increasing utilization of pathways as care management tools in the areas of development, implementation, and analytics. To address these concerns, ASCO published a policy statement on pathways as well as criteria defining high-quality pathways. The criteria were developed to assist providers and stakeholders in evaluating pathways. The most recent publication evaluating national vendors serves to assist all stakeholders in navigating the current pathway environment.
This is important for providers as oncology clinical pathways serve as valuable tools as practices transition to proving value-based care under the Medicare Access and CHIP Reauthorization Act (MACRA). Additionally, oncology clinical pathways may be leveraged in policies on healthcare delivery reform. (Read “The Path Forward for Clinical Pathways in Oncology” and “The Path Forward: Pathways and Practice Transformation” for more.)
What were some of the “exceptions” of pathway programs not being aligned with the criteria?
Rather than exceptions, ASCO’s pathway vendor assessment highlighted areas where pathway programs are currently focused on further developing their products to add value to payers, providers, and most importantly, patients. Much of the richness of the assessment is contained in the data supplement in the appendix. This section provides the detailed responses with respect to each vendor. A key area where we expect to see innovation is with respect to outcomes driven results – does the pathway program have analytics in place to enable a movement over time from adherence-driven compliance to outcome-driven results. Many pathway vendors are considering different approaches to achieving outcome-driven results including integrating claims data to better understand health care resource utilization (ED visits, hospitalizations) and survival data. One would imagine that as these pathway systems evolve they will become integral components of the learning health care system, illuminating for stakeholders which therapies or regimens would be the best choice for an individual patient, rather than all comers, at their specific point in the cancer journey by learning from the big data provided by past patient experiences.