Segment 4: How Rigorous Should Pathway Development Be?

Surabhi Dangi-Garimella, PhD, asked the panelists to comment on the thoroughness of the procedures adopted for the creation of clinical pathways.

“There is great variability in how pathways are developed,” according to Robert Dubois, MD, PhD. He referenced a recent analysis that was published by the National Pharmaceutical Council (NPC) in The American Journal of Managed Care that stemmed out of a survey conducted by NPC among various stakeholders. “What we found was extremely variable approaches to both the development and the implementation of the pathway,” said Dr Dubois.

Pointing to the need for stringent guidelines for developing these pathways, he added that the variability is multifactorial and may lend itself in the form of evidence used, outcomes evaluated, or whether expert assessment versus consensus is used.

According to Blaise Polite, MD, MPP, from a policy standpoint, clinical pathways—whether used to ensure quality or for preauthorization—“should have some sort of deeming process where we essentially bless pathways and say if you’re using a blessed pathway, then that pathway should be considered by all payers.” This process would also blend with healthcare’s movement to value-based pricing.