Can Clinical Pathways Shift the Healthcare Cost Paradigm?

The Center for Health Value Innovation (CHVI) presented a detailed overview on clinical pathways for oncology and how value-based approaches will help to improve health and financial outcomes.

A presentation by Jack Mahoney, MD, MPH, CMO of CHVI started by mentioning some staggering financial statistics as they relate to healthcare, such as how 10% to 12% of total healthcare spend is on oncology. A large reason for this, said Dr. Mahoney, is due to pharmacology therapy, which continues to grow at a rapid rate because of a very strong pipeline.

For employers who are caught in the middle of a complicated healthcare system, it’s imperative that they understand and manage long- and short-term costs. The optimal effect of healthcare is achieved when there is appropriate initiation as well as sustained and prolonged use.

Following Dr. Mahoney was Bruce Feinberg, DO, Chief Medical Officer and VP of Payors, Cardinal Health Specialty Solutions, Cardinal Health. Similarly, Dr. Feinberg began his portion of the presentation with some eye-popping financial statistics. The most sobering statistic was that the healthcare spend in the United States in 2010 was approximately $2.6 trillion, about 40% of which Dr. Feinberg estimates to have been “wasted” in a number of ways, such as frivolous medical testing. Dr. Feinberg spent the majority of his presentation focusing on end-of-life care and how significant changes must be made to improve the administration of second-line therapies, as well as to make patients stakeholders. Additionally, Dr. Feinberg spoke about how clinical pathways have the ability to improve patient care through treatment and behavior changes.

However, in order to adequately assess the potential of clinical pathways to transform care, we must first define clinical pathways. According to Dr. Feinberg, clinical pathways in oncology are guidelines that are a subset of the National Comprehensive Cancer Network. More importantly, these pathways must be the result of a collaboration between payers and providers. In doing so, stakeholder incentives can be aligned to drive high levels of provider participation and compliance to lead to behavioral changes in physicians. Clinical pathways have the ability to improve patient care and reduce unnecessary and costly treatment variation through standardized, evidence-based treatment practices.

analyzed the medical records of 215,000 Medicare beneficiaries who lost their lives to cancer. The study found that

50% of the

patients in the study were referred to hospice and that the average length of stay was 8 days. Additionally, 65% underwent a hospitalization in the last month of life for an average of 5 days, and 25% were admitted to the ICU for an average of 2 days.

Dr. Feinberg concluded by speaking for a moment about end-of-life care. He referred to an April 2012 study which appeard in Health Affairs and

“This is an overwhelming statement of failure in appropriate care, which requires us to change the paradigm,” said Dr. Feinberg.

Recommended ReadingLimits on Medicare's Ability to Control Rising Spending on Cancer Drugs [NEJM]End-of-Life Care for Medicine Beneficiaries With Cancer Is Highly Intensive Overall and Varies Widely [Health Affairs]Implementation of Cancer Clinical Care Pathways: A Successful Model of Collaboration Between Payers and Providers [AJMC]