June 28, 2017 | Written by: Partha Anbil
Categorized: Life Sciences
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Clinical pathways are formalized processes of care designed to reduce treatment variability. They can also be referred to as integrated care pathways (ICPs) or care maps. While every medical case is unique, payers and providers are attempting to standardize treatment since unnecessary variation is a major source of growing costs. These formalized processes may take the form of treatment guidelines, decision trees, and triage criteria. Many Integrated Health Systems (IHSs) are considering incorporating ICPs into their organizational strategy.
Clinical pathways serve to improve overall efficiency by:
- Managing the quality of healthcare with the goal of improving outcomes, via standardized care processes and reduced variability in clinical practice
- Promoting organized and efficient patient care based on evidence-based practices taking into account specific patient population considerations including access to medications and insurance coverage
Pathways recommend the best option from a pool of care guidelines to effectively regularize delivery efforts across their institution. By standardizing care with both a clinical and economic mindset, pathways are an important value-conscious care strategy for providers and payers. As clinical treatment guidelines and pathways are increasingly deployed, they have a growing impact on the quality of treatment and how it is delivered.
Implications of Clinical Pathways for Providers
Pathways have probably been most popular in the oncology space, due to a lack of quality metrics and generally high pharmaceutical costs. As pathways become are increasingly enforced, they pose to fundamentally change the role of physicians:
1. Maximize caregiver resource utilization
Pathways have led to improved coordination between caregivers by giving nurses the ability to pursue a pre-approved care treatment with minimal oversight. This saves physicians time which they can then use to improve patient care.
2. Change of provider decision-making power
It is imperative for health systems to gain physician buy-in when standardizing care. Any efforts to force pathways on caregivers are likely to fail. As a result, the Chief Medical Officer is often responsible for pathway formation and implementation.
3. Shift in physician incentives
Clinical pathway implementation is expanding on a greater scale in regional markets as dominant local/regional payers encourage greater pathway adoption through increasing levels of financial reimbursement attached to provider pathway usage.
The characteristics of effective clinical pathways are designed by physicians; evidence-based, updated regularly, informed through a formal physician feedback mechanism, evaluated for key data points on an ongoing basis and monitored for minimum compliance.
Potential implications of Clinical pathways
Institution of clinical pathways at the system level can likely result in major changes to pharmaceutical and imaging usage.
- Downward pressure on pharmaceutical volumes: Pathways are designed to regulate dosage and minimize the use of pharmaceuticals. Due to this increased regulation of physician behavior, pharmaceutical volumes may drop for select conditions with strong clinical pathways.
- Decreasing latitude for off-label usage in certain areas as pathways dictate what types of pharmaceuticals should be used in certain situations, certain off-label treatments may become difficult for physicians to use.
- Shift in the ‘key customer’ for adoption: Pathways will lead to shift of decision making power within the IDN (Integrated Delivery Networks) to be more centralized and at a higher level, thus making it challenging for pharma to sell drugs without demonstrating clear economic value for the IDN.
- Evolving drug positioning needs: There will be a need to closely track the evolution of pathways and adapt product launch and positioning at the right time depending on the indication especially in specialty products.
- Increased pathway development collaborations: Big pharma is fast moving towards collaborating with IDNs and payers to better help understand outcomes. Capitalizing on this trend will be key to maintain positioning in a transitioning environment.
IBM’s MarketScan Treatment Pathways is designed to help you work more efficiently by overlaying an online analytic interface onto large patient-level databases such as IBM® MarketScan®. MarketScan Treatment Pathways supports cross-sectional and longitudinal analyses, descriptive reporting, iterative exploratory research and quick querying, allowing studies or portions of study work to be completed without the need for data intake, software, or custom programming.
With faster speed to answers, improved visualization of analytic insights and boosted propensity scoring, Treatment Pathways now allows healthcare researchers to:
- Explore treatment sequences and transitions
- View time lapses in therapy
- Assess market share changes
- Analyze attrition rates for retail/specialty pharmacy scripts and office-based therapy
Read more about IBM’s MarketScan Treatment Pathways by clicking here.
As systems advance, IHSs will influence prescribing behavior via protocol driven medicine to limit brand access. Thus, it is important to segment evolving IHSs early with a pathway lens. There has been a rapid uptick in health systems with advanced capabilities who are increasingly adopting clinical pathways/protocols. Therefore, it is imperative for pharma manufacturers to gain a seat at the table for development of clinical pathways and protocols.