New Study Finds that Clinical Pathways Are Being Used to Improve Quality and Control Cost but Concerns Remain

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A new white paper from Avalere finds wide variation in how organizations develop and use clinical pathways (CPs)-multidisciplinary plans that provide specific guidance on the sequencing of care steps and the timeline of interventions. While CPs have the potential to improve quality and reduce cost, their growing use prompts a range of questions and concerns from patient advocates and healthcare providers. Specifically, Avalere's new work examines the lifecycle of a CP and explores the potential implications of growing use of these tools for payers, providers, and patients.
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As healthcare shifts from volume to value, payers and providers are increasingly implementing decision-support tools, such as CPs, to improve quality and control costs. Notably, most CPs in use today focus on oncology with increasing development for other high-cost and/or high-prevalence conditions. Given the increased use of these tools, we need to better understand how they impact patient experience, outcomes, and expenditures.

The interviews and research found that

  • Across stakeholders, the primary goals of CPs are to improve quality of care and reduce variation in treatments and costs.
  • There is wide variation in how organizations develop, test, and update CPs. Pathway developers differ in who is involved in committees that design pathways and the sources of evidence used. The testing or validation process is similarly variable.
  • Patients are not directly involved in the CP development process, except for the limited cases where patient-reported outcomes are explicitly used in the evidence to design the CPs.
  • There is limited evidence on the impact of CPs-pilot studies indicate potential for improved quality of care and reduced costs.
  • Some stakeholders raised concern as to whether CPs inhibit a physician’s ability to tailor care plans to unique patient needs, especially for those conditions with wide variability in disease manifestation and patient experience.

“Looking ahead, stakeholders need to work together to ensure that CP programs support the collective goals of patients, providers, and payers,” said Hillary Kleiner, co-author and director at Avalere. “A useful first step would be developing and instituting principles or standards for the development and deployment of clinical pathways.”

Read the full paper here.

Research Approach

Avalere’s research employed a multi-method qualitative study approach, based on data collected from published peer-reviewed and grey literature, publicly available reports, and semi-structured interviews with 15 stakeholders involved in or affected by CPs. To frame and guide the analysis, Avalere adopted the following definition of CPs:

Multidisciplinary care plans that are more prescriptive than clinical practice guidelines, providing specific guidance on the sequencing of care steps and the timeline of interventions. Further, CPs often, although not always, factor in the cost of care in treatment decision making.

Funding support for this research came from PhRMA.

Avalere maintained full editorial control over the content in the paper.

Avalere Health is a strategic advisory company whose core purpose is to create innovative solutions to complex healthcare problems. Based in Washington, D.C., the firm delivers actionable insights, business intelligence tools and custom analytics for leaders in healthcare business and policy. Avaleres experts span 230 staff drawn from Fortune 500 healthcare companies, the federal government (e.g., CMS, OMB, CBO and the Congress), top consultancies and nonprofits. The firm offers deep substance on the full range of healthcare business issues affecting the Fortune 500 healthcare companies. Avaleres focus on strategy is supported by a rigorous, in-house analytic research group that uses public and private data to generate quantitative insight. Through events, publications and interactive programs, Avalere insights are accessible to a broad range of customers. For more information, visit, or follow us on Twitter @avalerehealth.

1. Hoverman Rl, et al. “Opening the Black Box: The Impact of an Oncology Management Program Consisting of Level I Pathways and an Outbound Nurse Call System.” J Oncol Pract. January 2014.

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