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

A poster presented at the Academy of Managed Care Pharmacy 2021 meeting, April 12-16, 2021, examined how payers in the United States are using oncology clinical pathways (OCPs) to understand what drives their development and uptake and to delineate what barriers prevent 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% more than in 2014.

This research examined how OCPs initiated by payers affected 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, 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 the following:
• 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:
• Cost of medication for the cancer type

• Prevalence of the cancer type in the payer’s population
• Total cost of care linked with the cancer type
• Variability in treatment patterns for the cancer type
• Perceived 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 systematic literature
reviews, consensus guidelines, and value assessment frameworks.

Asked about barriers to implementing OCPs, respondents cited difficulty integrating OCPs with electronic health records 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.

Of the 25 respondents who did 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 the following:
• Unwillingness of the organization to limit provider choice
• Potential administrative burden for payers
• Pushback from providers

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

The authors noted the results had a few limitations, such as the small sample size and the fact that responses were voluntary, which may have overrepresented 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. Poster presented at: Academy of Managed Care
Pharmacy 2021; April 12-16, 2021. Poster U11.