Payer Interest in Oncology Clinical Pathways Continues

First implemented more than 10 years ago, oncology clinical pathways (OCPs) continue to be a method that payers use or are interested in adopting to ensure high-value cancer care, according to a poster presentation at AMCP 2021.

OCPs allow payers to manage oncology spending while also providing value-based care. According to a poster by Annie Yan, PharmD, MS, of Xcenda, Carrollton, Texas, prior research had shown expansion of the use of OCPs from 2014 to 2016, but data were lacking on recent trends.

This study assessed current trends for use of OCPs about U.S. payers. An electronic payer survey containing multiple-choice, open-ended, and Likert scale-rating questions was fielded in November 2020 to Xcenda’s Managed Care Network (MCN), a proprietary research panel of more than 160 healthcare executives, medical and pharmacy directors, and other experienced individuals in managed care.

In all, 18 organizations were currently using OCPs. Of these, 83% said their organizations plan to continue to use OCPs during the next five years. The most important reason for this was improving patient outcomes. Medical directors (89%) and oncology providers (83%) were the most common stakeholders involved in the development of OCPs. Multiple challenges related to OCP implementation were listed including difficulty integrating OCPs with electronic health records or other decision support tools, and an unknown return on investment associated with OCP development and use. When asked which components of care are incorporated into an organizations OCPs, responses included anticancer medications (100%), supportive care medications (72%), diagnostics (72%), labs (61%), radiation (44%), and surgeries (22%).

Twenty-five respondents did not currently use OCPs, but 56% of these said they lasted evaluated OCPs within the last two to three years. Additionally, 60% said their organizations were at least somewhat likely to implement an OCP within the next five years.

“Because all respondents voluntarily completed the survey, voluntary response bias may exist,” the researchers noted in their poster. “Survey results may over-represent organizations with higher interest in implementing strategies to manage oncology treatments and spend.”

Yan A, et al. Evaluation of payer-initiated oncology clinical pathways: utilization trends, development, and barriers to implementation. Poster U11. Presented at AMCP 2021; April 12-16, 2021.