Secondary Oncology Pathways Can Have Big Cost Impact

August 2014, Vol 5, No 6

Chicago, IL—The implementation of collaborative, secondary clinical pathway programs can improve outcomes and can lower costs when providers are already participating in another payer-sponsored pathway program. This conclusion comes from a study published online in conjunction with the 2014 American Society of Clinical Oncology meeting.

“Patients who enroll with providers who use pathway programs get more definitive outcomes-based treatment with more holistic care, because the providers are reminded to do not just the regimen-based prescribing, but also some of the other important care interventions that make a difference in keeping patients out of the hospital and giving you a better outcome,” said Ira M. Klein, MD, MBA, FACP, National Medical Director, Clinical Thought Leadership, Aetna.

Clinical pathways that guide evidence-based healthcare decisions have been shown to change practice patterns and improve health outcomes. In 2011, Aetna and Cardinal Health implemented an oncology pathway in which the dominant regional commercial payer, Blue Cross Blue Shield, had previously implemented a similar pathway program. “The clinical criteria of the 2 pathways were closely matched, and ours lined up with Aetna’s Clinical Policy Bulletins,” said Dr Klein.

In this new study, Aetna investigators compared the impact of the second-to-market pathway on cost of care. Claims data from July 1, 2010, through June 30, 2012, were used to evaluate the costs of managing patients with breast, lung, or colon cancer.

Chemotherapy, supportive care, emergency department, and hospital admission costs were compared for patients managed by providers participating in the secondary pathway program with patients managed by providers in only the primary pathway program.

Improved Outcomes
After adjusting the data to account for variations in tumor type and age, the cost per patient for chemotherapy and supportive-care drugs decreased by 18.3% in the group that was using primary and secondary pathways, and increased by 3.8% in the physician group that was only impacted by the primary clinical pathway. The average number of emergency department admissions also decreased by 0.8% among providers participating in the secondary pathway and increased by 8.5% among secondary pathway nonparticipating providers.

The difference in the drug-cost trend between participating and nonparticipating providers was 22%, resulting in a savings of $7037 per patient annually. The aggregated savings for drug costs and emergency department admissions was $7402 per patient annually.

“It is interesting to look at pre- and postbehavior when implementing an additional pathway to see whether your entry in as a contracted pay for value payer changes behavior a lot or whether some of the people are already doing a little of this,” said Dr Klein. “We postulate that it is very hard for 1 payer to get maximal savings out of this, but generally if 2 or more payers elect to enter a market, you tend to leverage behavior change to the max.”

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