Insight Into ASCO's Evaluation of Clinical Pathway Vendors

In February, the American Society of Clinical Oncology (ASCO) published the results from its evaluation of leading oncology clinical pathway (OCP) vendors nationwide. The review found that, overall, the clinical pathways offered by 6 commercial vendors are aligned with ASCO’s Criteria for High-Quality Clinical Pathways.

An article in Journal of Clinical Pathways provided insight into the evaluation by 2 of the report's co-authors—Robin T. Zon, MD, FACP, FASCO, chair, ASCO Clinical Pathways Task Force, and Bobby Daly, MD, MBA, Memorial Sloan Kettering Cancer Center.

Why the criteria were established

In 2016, ASCO established the Pathways Task Force to assess the role of pathways in oncology and determine characteristics of a high-quality OCP. The following year, they announced the Criteria for High-Quality Clinical Pathways, which include requirements that the OCP be expert driven, transparent, and up-to-date, and promote participation in clinical trials and have outcome-driven results.

The 2 authors explained that these measures were a response to ASCO's members expressing concerns regarding the increased utilization of pathways as care management tools for development, implementation, and analytics. The criteria were developed to aide providers and stakeholders in the evaluation of pathways.

Highlighting development

Instead of highlighting exceptions to alignment, the assessment highlighted areas in which the pathway programs are currently focused on further developing their products to add value to payers, providers, and patients. The authors said, “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?”

Different approaches being taken by the programs to achieve this goal include integrating claims data to better understand healthcare resource utilization, such as emergency department visits and survival data.

Lack of reporting public metrics

OCPs met fewer criteria when it came to having clear and achievable outcomes, as well as public reporting of performance metrics, demonstrating that, as pathway programs enter the healthcare delivery system, more information should be provided about the specific cancer type the pathway is intended to cover, as well as what constitutes on-pathway versus off-pathway treatment.

According to the authors, limitations in public reporting of performance metrics may be attributable to the preferences of the programs’ customers. “Providers and payers are just beginning to understand, assess, and learn from their pathway data, and prior to public reporting, this analysis needs to occur,” they said.

The most important takeaway

The authors emphasized that pathway programs continue to evolve, and in many respects have aligned with the original recommendations and criteria over time. This constant evolution involves self-analysis of quality outcomes and cost-effectiveness, as well as integration of new scientific and real-world evidence. They also noted that these programs represent an opportunity to improve and support high-quality, non-disparate, cost-effective care.

Using this information to improve practices

There are multiple reasons a practice may decide on pathway implementation, such as reducing emergency department visits and hospitalizations, improving quality of life measures, and optimizing practice efficiencies. According to the authors, as the amount of knowledge and treatments increase, along with the promise of real-world evidence, pathway programs that integrate these criteria can potentially serve as invaluable tools at the point of decision-making for the providers, while also helping to educate the patient.