Initial adoption of clinical pathways grew from payers mandating their use with individual providers, but there is now greater interest from accountable care organizations and others to use pathways to reduce variation and cost while improving outcomes, explained Robert Dubois, MD, PhD, chief science officer and executive vice president of the National Pharmaceutical Council.
Initial adoption of clinical pathways grew from payers mandating their use with individual providers, but there is now greater interest from accountable care organizations and others to use pathways to reduce variation and cost while improving outcomes, explained Robert Dubois, MD, PhD, chief science officer and executive vice president of the National Pharmaceutical Council.
Transcript (slightly modified)
How are pathways expanding into different healthcare delivery systems, such as accountable care organizations and integrated delivery networks?
When we began this work, we were quite aware of interest in oncology and quite aware of payers working with individual providers to say, “Ok, these are the pathways that we would mutually want to use.”
What we’re also finding is that there is interest beyond the payer being the group that says “These pathways would be good.” As physicians and physician groups and integrated delivery systems take on risk for managing patients over a longitudinal aspect of care, we’re finding greater interested by accountable care organizations, by these integrated delivery systems, to incorporate clinical pathways into what they do and how they do it. Not because it’s mandated by the payer, but because they, too, want to bring some of the same principles of reducing variation, improving patient outcomes, and reducing costs, just like the payers had.
So we’re going to see an evolution, over time, of much more broader pathways adoption.
Exploring Medicare Advantage Prior Authorization Variations
March 26th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the March 2024 issue of The American Journal of Managed Care® about their findings on variations in prior authorization use across Medicare Advantage plans.
Listen
The Pivotal Role of Payers in Improving Health Equity, Maternal Health Care in the US
March 26th 2024A presentation at the Greater Philadelphia Business Coalition on Health's 2024 Women’s Health Summit discussed how payers, including employers and public entities, can strategically influence health care purchasing to prioritize maternal health and equity.
Read More