Care Pathways: A Chat With NPC's Dr Robert Dubois

Each month, The American Journal of Managed Care hosts a Twitter chat (#AJMCchat) with a different expert. This month’s chat covered care pathways and featured Robert W. Dubois, MD, from the National Pharmaceutical Council (NPC) with participation from other individuals on Twitter.

Let's jump into it! Q1. What are clinical pathways & how do they differ from guidelines? #AJMCchat

— AJMC (@AJMC_Journal) January 28, 2016

Q1 #CarePathways = a method for managing #patient care based on clinical practice guidelines #AJMCchat 3/3

— NPC (@npcnow) January 28, 2016

Care pathways, or clinical pathways, are generally defined as a method of managing patient care. When there is the potential for cost savings, high disease prevalence, great diversity in treatment patterns, or multiple branded therapies, care pathways often come into play. Ultimately, care pathways are intended to improve the quality, variation, and efficiency of care, and allow physicians increased flexibility in tailoring care to suit a patient’s needs.

As stakeholders continue to push for quality and value in their healthcare, they are looking more and more to care pathways as a means of achieving this.

Q3 Goals of #CarePathways: improve quality, reduce variation & increase efficiency of care #AJMCchat

— NPC (@npcnow) January 28, 2016

How much further care pathways are expected to evolve is subject to debate. Already care pathways have expanded from the field of cancer, the original clinical area to use care pathways, to conditions like diabetes and hypertension. Other influences may include financial incentives for healthcare personnel (HCPs) or an increase precision medicine. (Although some opinions say that precision medicine will limit care pathways rather than be incorporated by them.)

Currently, care pathways are typically handled as bundled payments or episode-based payments. The benefit of this is that the focus shifts to the outcome rather than the process; these types of payments may also make budgeting easier.

Q5. Why do bundled payments and episode-based payments work well with care pathways? #AJMCchat

— AJMC (@AJMC_Journal) January 28, 2016

Q5: Fixed dollars/ budget Not all you can eat buffet style! #AJMCchat https://t.co/QrMlKwQnK6

— Kevin J. Fowler (@gratefull080504) January 28, 2016

Primarily, vendors, payers, and major oncology network providers develop pathways. Care pathways are regulated by a variety of sponsoring organizations including the National Comprehensive Cancer Network, which monitors pathways, and the American Social of Clinical Oncology (ASCO), which monitors the guidelines for care pathways.

There have been, however, some concerns raised about the design and efficacy of care pathways. Some critics argue that there is not enough involvement in the development of care pathways, lacking either provider input or healthcare provider buy-in—both populations are key to care pathway implementation. In spite of organization sponsorship, there are no formal standards for the development, implementation, and evaluation of care pathways, and little to no studies on the impact of these care pathways, including quality control, resource use, costs, and patient outcomes.

Especially prevalent is a concern about transparency with patients. Participants in the chat, emphasized the need for patient engagement, to include patient voices in the design phase as they will be the primary recipients of this care. Effectiveness can only be achieved with collaboration, dialogue, and consistency.

Q4 Transparency is key. Patients need to know they are being managed by a #carepathway #AJMCchat

— NPC (@npcnow) January 28, 2016

NPC stressed the importance of patient dialogue, citing their own study and that of ASCO as evidence. Both studies examined the challenges of care pathways, offered recommendations for their improvement, and sought more research on the matter.

In order to measure the success of care pathways, NPC recommended that pathway compliance, quality metrics, hospitalizations, and healthcare provider satisfaction could be examined.

Q8 We also agree with @ASCO on further research needed on #CarePathways impact #AJMCchat

— NPC (@npcnow) January 28, 2016

NPC strives to monitor the development and implementation of care pathways in order to improve care and reduce costs.

On the next page, you will find the full chat.