The quality of patient care often varies based on numerous factors, including health care setting, geographic location, access to medications, insurance coverage, and treatment protocols. Variations in health care are well established, and often lead to different services having varied outcomes depending on location.1–3 Recently, the issue of whether the use of clinical pathways—evidence-based treatment protocols designed to assist with the management of patient care—can decrease costs without reducing quality has been the subject of much discussion. The ability of pathways to reduce inappropriate variability in care is also at issue. Increasingly, payers are considering pathways in oncology when contracting with providers as a mechanism to improve quality, reduce variability, and decrease costs. This raises questions regarding what data are used to determine treatment options included in a pathway, the consistency with which they are monitored, how they affect reimbursement and insurance, and ultimately how they affect patient outcomes. As clinical treatment guidelines and pathways are increasingly deployed in oncology practice, they have a growing impact on the quality of treatment and how it is delivered.
NCCN, The US Oncology Network, and McKesson Specialty Health are collaborating to develop enhanced oncology pathways delivered through innovative technology, which will strengthen standards in evidence-based, high-quality cancer care and enable new forms of transparent provider and payer relationships. Called “Value Pathways powered by NCCN,” they are the next step in a collaboration to deliver a first-of-its-kind clinical quality and regimen support system, building on a solution initially developed by Proventys, Inc. as CDS Oncology.
This workflow-integrated software will allow physicians to assess treatment options consistent with evidence-based standards at the point of care. Value Pathways powered by NCCN, delivered through the clinical quality and regimen support system, is an important step forward in ensuring that patients receive the highest quality treatment while offering options to address the costs of cancer care.
NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines)—the most comprehensive and most frequently updated clinical practice guidelines available in any area of medicine—will serve as the foundational evidence source within the clinical quality and regimen support system and will be supplemented by the collaboratively developed Value Pathways. Anchored in clinical quality and evidence-based medicine, Value Pathways powered by NCCN will build on The US Oncology Network's Level I Pathways (discussed in more detail on page 121) and help patients receive the highest-quality care with the best opportunity for positive outcomes, while also recognizing the importance of value in determining appropriate treatment. These pathways will provide payers and employers with a quality-based program, developed by trusted oncologist-led sources through a transparent process, suitable to drive value-based reimbursement plans.
To develop the pathways, leading physicians of The US Oncology Network, supported by McKesson Specialty Health, will work with NCCN Guidelines Panel oncologists from NCCN Member Institutions. Initially, the new pathways will cover 19 tumor types, and will later be expanded to match the breadth of the NCCN Guidelines. Value Pathways powered by NCCN will reflect the collaborative effort of nearly 2000 physicians and oncology researchers affiliated with NCCN Guidelines Panels and The US Oncology Network. Ongoing development of Value Pathways will be 100% concordant with NCCN Guidelines and will leverage the pathways development process pioneered by The US Oncology Network's Level I Pathways and Pathways Task Force.
NCCN Guidelines are recognized as the gold standard across the industry. This collaboration builds on that standard by pairing the guidelines with new pathways to create a single set of content that we believe will enhance national best practices for optimal patient care and value-based outcomes in a completely transparent process. We also believe that the physician-led approach to developing meaningful clinical content—including rigorous peer review and updates based on the best science available—is a natural match between our organizations and that our complementary expertise will enable us as an industry to measure, track, and drive quality cancer care using the best, most up-to-date medicine.
Value Pathways powered by NCCN will be available in the spring of 2013 as part of the clinical quality and regimen support system. This first-of-its-kind software will allow physicians to access evidence-based content and review treatment options and their relevant clinical attributes against both Value Pathways and NCCN Guidelines at the point of care, integrated within their workflow. By creating this new technology, the system will allow oncologists access to up-to-date, peer-reviewed, evidence-based practice guidelines for cancer detection, prevention, and risk reduction; biomarker recommendations; and diagnosis, treatment, and supportive care for a multitude of disease sites. The clinical quality and regimen support system will be compatible with multiple leading electronic health record systems. In this way, we anticipate the Value Pathways powered by NCCN to increase efficiency within each practice, as well as quality and cost-effectiveness.
We are excited to work with McKesson Specialty Health and The US Oncology Network to offer Value Pathways and the NCCN Guidelines within the clinical quality and regimen support system. The NCCN Guidelines and the Level I Pathways have helped clinicians and payers address variations in treatment and improve oncology cost trends by emphasizing evidence and focusing on the quality of care. We aim to use our combined expertise to continue this mission and enhance care by offering one standard set of content, through a new accessible format.
Morden NE, Chang CH, Jacobson JO. End-of-life care for Medicare beneficiaries with cancer is highly intensive overall and varies widely. Health Affairs 2012;4:786–796.