Five Keys to Implementing a Successful Oncology Pathways Program

Delivering quality care in oncology is becoming more complex. Many of the factors that add complexity have accelerated and responding to these changes has a ripple effect on oncology practices. The explosion of treatment options contributes to unwarranted care variation and increases the amount of time oncologists need to stay abreast of changing treatment paradigms. In turn, the shift to value-based care models, rising cost of therapies and reductions in reimbursement margins have added uncertainty to the financial performance of oncology practices.

With these changes, the need for your practice to perform predictably and sustainably is paramount. Otherwise, you may experience financial uncertainty impacting your ability to deliver quality care.

Evidence-based oncology pathways embedded in the clinical workflow have been shown to reduce unwarranted care variation, help to improve care quality, and lower costs for your institution. However, pathways are not simply a stand-alone decision support tool – to achieve these goals, pathways need to be part of your broader quality improvement program. A quality pathways vendor partner should guide you through this process from implementation until long after your program has been established to ensure sustainability and success.

Read on to understand the five most important components to establish a successful pathways program, to standardize care, and to improve the predictability of your practice’s performance.

Leadership Commitment

While this might seem obvious, leadership commitment is the single most important factor in the success of your clinical pathways program. The commitment to care standardization starts at the top and is critical to driving physician engagement. Strong clinical and operational leaders work together to: * Communicate to their teams how pathways support care standardization and improve quality * Reward their physicians for consistently using pathways, such as through citizenship incentives * Monitor practice patterns to identify and address areas of unwarranted care variation Your pathways partner should support you in this journey through ongoing touchpoints to discuss practice trends and share best practices. When you and your organization commit to a culture of quality improvement, you are not alone – rather, you leverage the expertise of your pathways partner to embed best practices into your clinical and operational processes.

Clinical Workflow & Integration

Once your leadership team is committed to quality improvement, the next biggest driver of physician engagement is making the pathways seamlessly accessible from within your EHR. This process starts during implementation and has two elements: clinical workflow and technical integration. Clinical Workflow: As you stand up your pathways program, it is critical to analyze your existing workflow to explore how pathways can provide support. These decisions include:

• Identifying who will be accessing the pathways (physicians, nurses, etc.) and when they navigate the pathways (e.g., for new treatment starts only, for all treatment changes, etc.)

• Determining which materials will be embedded into your workflow (e.g., patient-specific treatment plans, consent forms and patient education materials)

• Defining the operational support your pathways tool will provide (e.g., action-driven messaging, which sends secure, real-time notifications to your support staff for care coordination)

• Technical integration: Once you have defined the clinical workflow, your technical team and pathways provider can work together to establish:

• Secure connectivity between your EHR and pathways solution, allowing data to flow in a HIPAA-compliant manner

• Single sign-on for your physicians, delivering a seamless user experience

• Bi-directional interfaces to transmit data between your EHR and pathways solution, reducing the need for duplicative data entry

• Regimen mapping between your formulary and pathway regimens, to automatically queue up the selected treatment order at the end of a pathway navigation

Your pathways partner should provide personalized implementation services to support your team in defining the clinical workflow and establishing technical integration. When oncology pathways become a natural part of your institution’s workflow, you empower your physicians to make complex decisions prospectively, instead of retrospectively after the patient consult. Not only do you relieve some of the administrative burden, you also reduce the risk of patient errors that might arise from physicians manually setting up an order.

Physician Engagement

Once the clinical workflow and technical integration are in place, effective physician engagement is required to sustain consistent use of the clinical pathways. There are a multitude of ways you can drive engagement, including: * Assigning “super-users” who can help their peers with common questions

• Identifying champions for each academic and community site to engage physicians across your institution’s network

• Engaging disease-oriented teams to build a culture around using pathways to deliver quality care within a specialization

• Encouraging physicians to participate in disease committees where published evidence is discussed and pathway recommendations are determined

• Incorporating clinical trials into the pathways to support research-oriented physicians in accruing patients to their studies

Clinical Trials

To support you in your physician engagement efforts, your pathways partner should provide hands-on training to each physician in your network. Using regular touchpoints together to discuss pathway usage rates, on-pathway rates and the reasons where physicians have gone off-pathway has also shown to be beneficial. With these data, your medical directors can have empathetic, data-backed conversations with your physician team on practice patterns across the institution.Positioning your clinical trials program for success is another key facet of maximizing the value of pathways. Pathways have been shown to increase clinical trial accruals and can support your institution in its research goals by:

• Mapping clinical trials to pathway branches based on inclusion and exclusion criteria so that only the most relevant trials are presented

• Presenting your institution’s clinical trials ahead of standard of care treatment recommendations

• Sending a secure message to your clinical research team when a patient is recommended for a screening

• Capturing data on patient trial screening and reasons why patients were not screened

Your pathways partner should work with your institution’s clinical trials team to identify the relevant trials and build these into the pathways, in addition to using regular touchpoints to discuss trends around patient screening and trial placement. With clinical pathways supporting your research program, you can increase the number of patients accrued to trials, support your institution in achieving or maintaining research accreditation, and access research grants for innovative care delivery.AnalyticsThe ability to capture timely, structured and complete data is one of the most compelling reasons to adopt a pathways program. Oncology pathways capture detailed data which allow you to accurately track:

• Patient presentations, including case volumes segmented by disease, stage and presentation

• Practice patterns at every level, from the network or practice site to the individual physician

• Appropriate testing of biomarkers and use of precision oncology treatments

• Clinical trial screening rates by pathway branch

Your pathways partner should provide timely data on impactful metrics such as capture rates, on-pathway rates, and reasons for off-pathway decisions. With these advanced analytics, you can identify areas of unwarranted care variation and adjust your quality improvement efforts accordingly. These data are also critical to supporting your institution in performing predictably in value-based care programs.