The Lynx Group

Innovation in Practice Management Abstract

April 2014, Vol 5, No 3

Improving Oncology Quality Through the Implementation of Evidence-based Clinical Pathways in a Payer’s Oncology Network
Daniel McCrone, MD; Dudley Gill, MBA; Cecilia Tran, PharmD, BCOP; Michael Sturgill

Background: Physicians and health plans are collaboratively exploring clinical pathway strategies to improve patient outcomes, reduce treatment variation and reduce oncology cost. Studies have demonstrated that the use of pathways can lower the cost of care and that oncologist participation is a critical element for success.

Objectives: New Century Health (NCH), in partnership with a leading health plan and one of its Midwestern oncology networks, had two quality goals with the implementation of a chemotherapy prior authorization system:

  • Review all chemotherapy regimens for all patients
  • Measure treatment plan adherence to evidence-based clinical pathways
Methods: As one component of a mandatory chemotherapy prior-authorization program, an online prior authorization system was used by oncology practices to submit chemotherapy treatment plans to NCH for approval. The system:
  • Captured detailed patient clinical information
  • Measured compendium and preferred pathway adherence rates. These data were shared with participating oncology practices on a quarterly basis.
For analysis, an average Baseline compendium adherence rate was determined reflecting participating practices for six cancer diagnoses (Breast, Colon, Lung, Lymphoma, Multiple Myeloma and Prostate). The Baseline rate was compared to the Review period rate.

Results: A comparison of the Review and Baseline period metrics indicated a statistically significant increase in the level of compendium-based chemotherapy treatment plans submitted by participating providers.

Conclusions: Implementation of an oncology prior authorization system that measures compendia-based adherence rates is associated with increased levels of evidence-based chemotherapy treatment plans by participating providers.

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