Oncology: Pathways to Progress - Pharmaceutical Executive

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Oncology: Pathways to Progress


Pharmaceutical Executive


There is a larger dimension too, in moving the research forward to help patients and providers make better choices—to build in greater clinical precision, relevance and value—at the actual point of care. We have done that to date through Level I Pathways, and in the future will be continuing this effort through our new Value Pathways powered by the National Comprehensive Cancer Care Network [NCCN], the output of our recently announced collaboration with them. Level I Pathways are a series of refined guidelines, developed by physicians and clinicians from our US Oncology Network, to help oncology practices assess the most effective and least toxic care options for patients using standardized, evidence-based software analytics. Physician specialists lead the initiative, with additional input from the clinical pharmacy community. The pathways represent a careful balancing of the science—including efficacy and toxicity—with a broader value assessment that incorporates cost and leaves room for consideration of factors unique to the individual patient. We refer to this latter element as the 80/20 rule, with the 20 percent being the weight each pathway gives to the physician's judgment after weighing all the scientific evidence. The absence of a "one size fits all" mandate is one reason why physicians have really bought in to the process. They see us as one of their own.

As noted, this year we are launching an expansion of the pathway initiative with the NCCN. The US Oncology Network and NCCN are jointly developing a "Value Pathways Powered by NCCN" program of peer-reviewed disease management protocols for 19 tumor types, with additional plans to support cancer detection, diagnosis, biomarkers recommendations, treatment, and supportive care. Each will build on existing NCCN Guidelines—the gold standard for clinical practice in oncology—to add the value-based metrics, including cost evaluations, developed previously for our Level I Pathways. In addition, the Value Pathways Powered by NCCN can be accessed through software designed to be integrated with the electronic health record and other data workflows of practices or hospitals, creating a new standard for content and technology, and helping providers focus on the best way to enhance outcomes for their patients. Most important, the Value Pathways will rely on the timely input and expertise of 2,000 practicing oncologists and researchers affiliated with the NCCN Guidelines Panels as well as some 1,000 community physicians active in the US Oncology Network.


Neelima Denduluri, Lead Investigator, McKesson US Oncology Research
Lyn Fitzgerald, National Comprehensive Cancer Care Network: This collaboration addresses a need that state oncology societies have identified relative to our guidelines, which is helping the oncologist community use the guidelines effectively. What is particularly useful about the McKesson collaboration is the power of the technology and the Value Pathways Powered by NCCN, both of which supplements the content of the NCCN Guidelines, thus providing the necessary tools and information that meet the increasing evidence requirements of the payer. The technology will empower them with the evidence based information to interpret, act and do what's right for each patient, all at the point of care and within normal work flow.

Dr. Neelima Denduluri, Virginia Cancer Specialists: I am a practicing oncologist and member of The US Oncology Network Pathways Taskforce and Breast Research Committee. The Value Pathways project advances the idea that scientifically-based standards of care actually increase the autonomy of the physician and safeguard the interests of the patient. When members contract with payers, we do so with the capacity to demonstrate that having more options and flexibility in treatment is actually a cost saver because it leads to better outcomes. The standards are there, but are not so rigid as to allow payers or other stakeholders to dictate the terms of engagement. We can show that when physicians are allowed to police themselves, excess and waste—crazy things—don't take place.


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