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Clinical Progress and Coverage Policies in Immuno-Oncology

Clinical Pathways

As his organization is not currently working with a particular clinical pathway construct in oncology, Steven Peskin, MD, MBA, FACP, describes the alternate resources that Horizon Blue Cross Blue Shield of New Jersey uses when making coverage decisions.

Steven Peskin, MD, MBA, FACP: We have not embraced clinical pathways in the way that we’re saying that we’re working with a particular third-party clinical pathway company.

What we are doing is working around episode-of-care type of contracts. Within those clinical organizations, they are, in turn, setting certain standards and looking at certain pathways. They’re looking at their clinicians in their organizations [to see] if they’re following certain protocols—[for example, regarding] the judicious or injudicious use of PET/CT (positron emission tomography/computed tomography) scans, and which therapies are being used in what situations.

So we have not, as an organization, embraced a particular clinical pathway construct. Though we certainly see the great value in evidence-based care (evidence-based medicine), we’re not specifically focused on a particular clinical pathway, [having a] third party work with us, or [establishing] our own approach to designated clinical pathways.
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