Segment 14: The Future of Clinical Pathways

The panelists provided their final thoughts on where they see the need for improvement in clinical pathways and what they think the future holds for this field.

Blaise Polite, MD, MPP, highlighted the important role that pathways will play in the world of alternative payment models. Polite is personally against the bundled payment models. He argues that oncologists are not responsible for the launch price of drugs and should not be penalized for using these high-priced drugs if they are using them appropriately. “I think [pathways] have a lot of ability to help us in new payment worlds,” he said.

Agreeing with Dr Polite, Kathy Lokay said that helping individuals understand that they do not necessarily have to take risks with the way they use drugs and treatments is important. “Maybe pathways are a better way to control utilization, and they don’t really put the physician and the patient in the middle when costs go up.”

Michael Fisch, MD, MPH, emphasized that pathways are a value framework, in a sense, because they summarize clinical evidence while weighing-in costs and outcomes. He added that despite the differences in specific choices, there is enough concordance between pathways created by different pathway developers, considering that the pool of clinical evidence is the same. While pathways will continue to evolve with the accumulation of longitudinal data, “there’s widespread acceptance of the specific choices that are involved in the pathways because they’re familiar and evidence-based,” Dr Fisch said.

Robert Dubois, MD, PhD, believes the field of clinical pathways is relatively young and requires improvements in multiple aspects. In addition to gathering more long-term data, outcome measures that ensure patient performance are necessary, he said. “As we progress [in this field], we need to compare different sites that are using pathways or not, patients that are on the pathways or not. Making certain that patient outcomes are the way they need to be. If they’re not, then we revise the pathways and move forward accordingly.”