Washington, DC [April 21, 2016] – Because sequenced care plans, called clinical pathways, now shape the treatment decisions for an increasing number of cancer patients, an initiative called Project Innovation unveiled Decoding Clinical Pathways, the first online resource for the public that explains what pathways are and how they affect cancer care today. The goal is to help patients understand factors that are shaping their care, and if theirs is governed by a pathway so they are better prepared to weigh available treatment options with their physician and care team. Project Innovation is a campaign to elevate advancements in cancer treatments as a national priority.
Coinciding with the publication of the policy paper, “Recommendations for the Role of Clinical Pathways in an Era of Personalized Medicine,” on April 13, 2016 in the American Journal of Managed Care, the new module comes at a time when the use of pathways is expanding and evolving. Authored by cancer specialists working with the National Patient Advocate Foundation (NPAF), the paper reports that many hospitals and physician practices now use pathways to translate published medical practice guidelines into the essential steps for treating a specific disease or condition. When properly designed and implemented, these pathways help steer patients and providers to evidence-based treatment options that take into account such factors as efficacy and safety along with cost.
However, the NPAF paper cautions that pathways can also be oriented more towards “cookie-cutter” approaches that can preempt shared decision-making between doctors and patients and interfere with physicians’ clinical judgement. This is of increasing concern as insurance companies implement their own care plans as a way to control costs and in some cases, pay bonuses to doctors for prescribing “on pathway” treatments. The American Society of Clinical Oncology (ASCO) estimates that 60 individual health plans are currently implementing oncology pathways, particularly for breast, lung and colorectal cancers.
Responding to these developments, the online guide introduces the concept of pathways to patients and caregivers, most of whom have never heard the term before, and serves as a primer on the purpose of these care plans, the likely benefits of patient-focused pathways and the potential limits restrictive versions may impose on available treatment options and patient access to emerging personalized therapies. The Decoding Clinical Pathways module is available on the Project Innovation website at: www.projectinnovation.org
“For too long, the discussion about cancer clinical pathways has been limited to physicians, insurance companies and policymakers even though patients are directly affected by how these care plans are designed and what they cover,” said Alan Balch, PhD, chief executive officer of the Patient Advocate Foundation (PAF), which manages Project Innovation. “Our goal is to equip patients and caregivers with user-friendly information about pathways so they will know what questions to ask and be prepared to weigh treatment options with their oncologist.”
The Need for Transparency
Today, clinical pathways are used to manage cancer and other challenging diseases, such as congestive heart failure and diabetes. When applied to cancer care, these protocols are intended to allow oncologists and patients to weigh treatment regimens based on different safety and effectiveness profiles, improve outcomes and drive value in the health system.
Conversely, some pathways erode the doctor-patient relationship and the overall quality of cancer care by limiting or precluding treatment options that may be appropriately personalized to an individual patient, which is why the NPAF policy paper states: “Patients need to be aware, not just of how options on pathways were chosen, but also of what other alternatives are viable, according to guidelines, that may not be listed in the pathway. Patients can then have an honest consultation with their physician about the various risks, benefits, and costs associated with each viable option.”
Reflecting this position, ASCO published a policy statement with nine recommendations to improve clinical pathways and the National Patient Advocate Foundation issued a set of Guidelines for Clinical Pathway Design and Development, calling for all clinical pathways to support shared decision-making and reflect patients’ preferences for how to individualize their care. However, until these recommendations are enacted, the online module encourages patients to take action themselves by asking these questions of their oncologist:
- Is my treatment determined by a clinical pathway?
- If so, what treatment options are available through the pathway for my diagnosis and why were they chosen?
- Does the pathway include the option of enrolling in a clinical trial?
- What happens if the most appropriate treatment is not covered by the pathway? Are there ways that the health plan will cover this treatment?
- Does the insurance plan give financial incentives to the oncology practice for following the pathway?
Further, the online module recommends patients and caregivers take advantage of new rules under the
Affordable Care Act (ACA), which require insurance companies to make available in concise, easy-to-understand language what their health plans cover. Ways to get information on the drugs covered through the health plan are to:
- Visit the insurer’s website to review the list of prescriptions the plan includes
- Ask the insurance company to provide the “Summary of Benefits and Coverage,”
- a form that summarizes the key features of the plan, such as the covered benefits, cost-sharing provisions, and coverage limitations and exceptions
- Call the insurance company directly to find out what drugs are covered
About Project Innovation
Launched in June 2014 and spearheaded by the Patient Advocate Foundation (PAF) and National Patient Advocate Foundation (NPAF), Project Innovation is a national movement designed to accelerate the pace of medical discovery in cancer, deliver safe and effective breakthrough therapies to patients quickly and save lives. Through Project Innovation and its complementary policy development initiative, the Cancer Innovation Coalition, stakeholders have joined forces to address the barriers slowing the pace of biomedical research and limiting patient access to much needed treatment. More information about Project Innovation is available at www.projectinnovation.org, @projectinno on Twitter and https://facebook.com/ProjectInno on Facebook.