Oncology Care Pathways Launched by Payers: What Are the Trends?

A recent poster presented at the Academy of Managed Care Pharmacy 2021 meeting examined how payers in the United States are using oncology clinical pathways (OCP) to understand what drives their development and uptake and delineate what is standing in the way of further OCP adoption.

The use of OCPs, which first appeared about a decade ago, has grown in recent years; in 2016, they were used by 58% of oncology practices, which was 42% higher than in 2014.

This particular research examined how OCPs initiated by payers affect access to oncology treatments, as payers seek ways to manage high-cost oncology care while ensuring value-based care.

The research was conducted by Xcenda, part of AmerisourceBergen.

An electronic payer survey containing multiple-choice, open-ended, and Likert scale-rating questions was sent in November 2020 to Xcenda’s Managed Care Network (MCN), the company’s research panel of more than 160 managed care professionals. Forty-three responded; 35% were medical directors and 65% were pharmacy directors.

Of the 43 respondents, 18 (42%) said they were currently using OCPs, and 16 (37%) were considering it.

The top 5 reasons for using OCPs included:

• Improve patient outcomes
• Reduce oncology care variations
• Improve overall quality of care
• Decrease the total cost of care
• Decrease costs linked with anticancer drugs

The top 5 considerations when deciding which cancer types to include in the OCP were:

• The high cost of medication for the cancer type
• The high prevalence of the cancer type in the payer’s population
• The high total cost of care linked with the cancer type
• The high variability in treatment patterns for the type
• Perceived suboptimal management of the cancer type

When asked what kinds of evidence are used to create OCPs, the top 2 sources cited were clinical guidelines and peer-reviewed literature, followed by systemic literature reviews, consensus guidelines, and value assessment frameworks.

Asked about barriers to implementing OCPs, respondents cited difficulty integrating OCPs with EHRs or other clinical decision support tools; unknown return on investment associated with OCPs; misaligned incentives to adopt OCPs; lack of timely OCP updates; and difficulty training staff on OCPs.

The survey also queried the 25 respondents who do not use OCPs. About 60% said their organizations were “somewhat likely” or “very likely” to implement an OCP.

Reasons for not implementing an OCP included:

• Unwillingness of their organizations to limit provider choice
• Potential administrative burden for payers
• Pushback from providers

The potential return on investment, the ability to measure outcomes, and buy-in from oncology providers were the top 3 factors influencing whether the organizations thought OCPs might launch in the next 5 years.

The authors noted that the results had a few limitations, such as the small sample size and the fact that responses were voluntary, which may have over-represented groups with a keen interest in OCPs.

Reference

Yan A, Cook S. Evaluation of payer-initiated oncology clinical pathways: utilization trends, development, and barriers to implementation. Presented at: The Academy of Managed Care 2021; April 12-16, 2021. Poster U11.