https://www.hmpgloballearningnetwork.com/site/jcp/feature-story/oncology-pathways-drive-adoption-high-quality-treatment-regimens-and-deliver

Abstract

In an environment of rapid innovation and sharply rising costs, on­cology clinical pathways are a solution that can help bridge knowledge gaps for providers and ensure patients get quality, affordable cancer care. Cigna and evi­Core Healthcare developed an Oncology Value-based Pathways (VP) program by incorporating several value frameworks and considering the perspectives of multiple stakeholders, including patients, providers, and payers. Starting Janu­ary 1, 2021, the VP program was implemented for a large commercial population, spanning 51 clinical pathways and covering 50% of cancers. Over an 18-month period, the VP program increased the on-pathway regimen rate by 5.2%, leading to a cost savings of $24 million or $0.13 per member per month in a commercial managed population. Direct peer-to-peer conversations with providers who or­dered off-pathway regimens led to updated requests for on-pathway regimens in 18.3% of cases. Additionally, 28.3% of total cases were moved to on-pathway regimens, regardless of whether there was a peer-to-peer discussion with the provider, indicating the VP program’s durable educational impact.