ASCO Framework Can Help Providers Assess Clinical Pathway Programs

By developing 15 inter-related criteria that constitute a framework, the American Society of Clinical Oncology (ASCO) has released the Criteria for High-Quality Clinical Pathways in Oncology, which is expected to help providers assess the quality, utility, and integrity of pathway programs in the United States.

Clinical pathways are a structured approach to reducing variance in healthcare utilization and, subsequently, controlling the cost of care. Academic medical institutions, provider organizations, and health plans have all adopted pathway programs in an effort to potentiate high-value care. However, identifying the appropriate program for a practice is essential, and with so many vendors to choose from, ASCO thought it necessary to develop the guideline that was released today.

At the beginning of 2016, ASCO released a policy statement to help providers address some of the concerns with payer-developed pathways, including their ability to address the entire spectrum of cancer care, as well as the additional administrative burden that they might place on physicians, further limiting their time with patients. Robin Zon, MD, FACP, FASCO, who chairs ASCO’s Task Force on Clinical Pathways, wrote in Evidence-Based Oncology^TM that the purpose of the policy statement was 3-fold:

• To increase awareness about the growing use of clinical pathways in oncology and concerns that exist about the manner in which they are being deployed.
• To ensure quality, transparency, and consistency in the design and implementation of these treatment management tools.
• To ensure that pathways are used in the way they are intended to ensure quality care and reduce costs.

“ASCO’s efforts to promote value in cancer care are multi-pronged and include participation in the Choosing Wisely campaign, publication of multiple statements on cost and value in cancer care, development of a new oncology payment model focused on value (not volume) and, most recently, development of the ASCO Value Framework,” Zon told The American Journal of Managed Care^® in an e-mail. “Like the ASCO Value Framework, clinical pathways in oncology can serve as an important tool to help oncologists identify treatment options that represent the highest quality and value for an individual patient’s disease state and circumstances.”

In an effort to reduce the wide variations among pathways programs, which, according to Zon, can impact “patient access, quality of care, and transparency,” ASCO has presented providers with the following criteria:

1. Expert-driven. Do practicing oncology providers play a central role in the pathway development?
2. Reflects stakeholder input. Is there a way for stakeholders to provide input during the development process?
3. Transparent. Is there a clear, consistent process and methodology for pathway development, and is relevant information disclosed to stakeholders and the general public?
4. Evidence-based. Is the pathway based on the best available scientific evidence?
5. Patient-focused. Does the pathway include evidence-based options to account for differences in patient characteristics and/or preferences?
6. Clinically driven. Is there an established methodology for prioritizing efficacy, safety, and cost? Are stakeholder assessment and analysis used to revise the pathway?
7. Up-to-date. Is the pathway updated in a timely way as relevant new information becomes available?
8. Comprehensive. Does the pathway address the full spectrum of cancer care? If the pathway is not comprehensive, does it clearly describe the phase and elements of care it is intended to address?
9. Promotes participation in clinical trials. Are available clinical trial options incorporated in the pathway?
10. Clear and achievable expected outcomes. Is information provided on the specific cancer type that the pathway is intended to cover, and what constitutes on-pathway versus off-pathway treatment and goal adherence rates?
11. Integrated, cost-effective technology and decision support. Does the pathway comply with federal mandates for Meaningful Use of electronic health records (EHRs), and does it offer—or plan to offer—resources that can be integrated into commonly used EHRs?
12. Efficient processes for communication and adjudication. Does the pathway provide references that may support pathway variation, inform the provider in real time of pathway compliance, and offer a mechanism for choosing an off-pathway recommendation?
13. Efficient and public reporting of performance metrics. Does the pathway offer providers and the public with reports on provider performance over time and compared with other groups of providers, and do such reports reflect valid occasions when the provider has gone off-pathway?
14. Outcomes-driven results. Does the pathway have analytics in place to enable a movement over time from adherence-driven compliance to outcome-driven results?
15. Promotes research and continuous quality improvement. Does the pathway demonstrate a commitment to research aimed at assessing and improving the impact of pathways on the patient and provider experience, clinical outcomes, and value?

Zon believes that independent of the site of service, “These criteria can be utilized in a manner that enhances the ability of the provider to evaluate pathway programs, including those already implemented, as well as for programs under consideration by practice management.” In addition to optimizing their existing pathways programs, practices could potentially collaborate with various stakeholders to review pathway programs, while keeping the proposed criteria in mind.

Additional details on the criteria can be accessed here.