From pathways to practice
The Value Pathways are a reflection of how rapidly the financing and delivery model in oncology is changing, uprooting the
traditional relationship between a passive payer, segmented providers and powerless, information-poor patients. Is the industry
ready and prepared to help facilitate application of the Pathway model? What "influencers" might be missing to ensure this
new tool is used most effectively?
Steven Stein, Novartis
Dr. Steven Stein, Novartis: The objective of a treatment guideline is to try to change physician behavior. You can apply the carrot, or the stick. I'm
interested in how these pathways promote practitioner compliance with the standardized parts of the package—what you refer
to as the 80 percent of the pathway that is prescribed decision support. Physicians clearly prefer being autonomous and acting
on their own discretion, so is there any "punishment" for not staying compliant within that 80 percent?
Denduluri: We don't believe in negative incentives like penalties. The pathways are structured to advance excellence in patient care
first and foremost as well as build confidence and foster a spirit of partnership between providers and payers. Involvement
of the NCCN and incorporation of its extensive information base is crucial to this process. To the payers, we can show that
the standards we set are sufficiently stringent because they are based on hard evidence drawn from the literature and actual
clinical experience. We can furnish data on just where the pathways have yielded lower costs and similar or better outcomes.
This in turn allows us to tell the network physicians that compliance with the standards means that payers will be more willing
to negotiate higher payments. It's positioned so that both sides see a benefit in upholding their core interests.
Coker: Internal peer pressure also keeps the practice community aligned. One of our network practices, Rocky Mountain Cancer Center,
monitors performance of its oncologists around the pathways and requires physicians with variations against the norm to answer
to the other physicians in the group why that is the case. There is no sanction against the physicians' judgment, bar the
fact that they must explain to their peers why their performance is out of range. The transparency keeps people honest and
encourages predictable, fiscally responsible behavior.