Clinical Pathways Lead to Reduction in Spending Within the Oncology Care Model

In a study, published in the Journal of Clinical Oncology: Oncology Practice, researchers demonstrated that the reduction of drug spending by using value-based clinical pathways to optimize chemotherapy utilization is possible and can increase the chances of a practice’s success within the Oncology Care Model (OCM). 

Researchers indicated that misguided perceptions that drug prices are outside the control of oncologists has led to many OCM participants focusing their efforts on other areas to reduce costs, such as reducing preventable emergency department visits and hospital admissions.

“This perception fails to account for the documented success value-based clinical pathways have had in reducing drug spend with no change in clinical outcomes,” the authors wrote. “Given the high percentage of the total episode cost that drug spend accounts for, small improvements in utilization can result in larger savings than a decrease in hospitalizations, which account for < 20% of the spend.” 

During the study, Cancer Care Specialists of Illinois (CCSI), which was participating in the OCM, used value-based clinical pathways for OCM-attributed patients. To measure real time clinical pathway adherence, all treatment plans were submitted to the pathway vendor. Researchers conducted their analysis before implementation and on an ongoing daily and weekly basis to identify cases in which higher cost drugs or regimens were ordered.

A clinical data governance committee met biweekly to review the clinical pathway performance metrics and drug utilization. Data on drug spending was compiled from a combination of Centers for Medicare and Medicaid Services feedback reports, quarterly data reports, Medicare claims data, and reconciliation reports specific to the evaluation period.

Overall, from quarter 1 of 2017 to quarter 1 of 2019, the median amount of drug spending increased less rapidly for CCSI (18.6%) compared with OCM (34.4%). Further, the percent difference in drug spending for CCSI relative to OCM decreased from 13.5% to 0.1% (P < 0.001). Additional analyses also found that, over a 15-month period (October 2017 through December 2019), CCSI demonstrated an increase in pathway adherence from 69% to 81%.

“It is noteworthy that the 13.5% reduction in spend versus the OCM median occurred in the absence of any prior authorization; it is comparable to drug- spend reductions that NCH has seen when using its pathways as part of a prior authorization program in Medicare Advantage plans,” the authors wrote. “This suggests that with more aligned payment models, in which physicians share in the value created, prior authorization may not be necessary. 

An important aspect of this study that the authors suggested cannot be disregarded is the willingness on the part of the physicians to look at their prescribing behavior and agree to implement change. Over time, this could evolve into a streamlined discussion in which physicians could hold each other accountable, such as seen in the bi-weekly meetings described in the study. 

The researchers indicated that though these changes would take time to fully implement, this type of peer influence and shared sense of accountability would contribute to the sort of results achieved in this study. Moreover, though there is time trade-off to first check pathways before prescribing a treatment, the payoff is the ability to quickly prescribe outcomes-based regimens that will ultimately lower the total cost without detracting from quality. 

“However, analysis of additional oncology practices using [New Century Health; NCH] pathways will be required to determine whether pathways are more effective in practices with higher versus lower drug spend,” the authors wrote. 

Reference:

Hertler A, Chau S, Khetarpal R, et al. Utilization of Clinical Pathways Can Reduce Drug Spend Within the Oncology Care Model. JCO Oncology Practice. doi:10.1200/JOP.19.00753.