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Dr Edward Arrowsmith: Trust and Compromise Are Essential in Building Oncology Clinical Care Pathways


Edward "Ted" Arrowsmith, MD, MPH, medical director for pathways at OneOncology and managing partner at Tennessee Oncology, highlights the need for trust between payers and providers, as well as finding balance in building consistent clinical pathways while prioritizing specific practice needs.

Collaboration between payers and providers is crucial for developing effective oncology care pathways, and at Tennessee Oncology and OneOncology, physician-led initiatives ensure legitimacy and consensus in decision-making, explained Edward "Ted" Arrowsmith, MD, MPH, medical director for pathways at OneOncology and managing partner at Tennessee Oncology.

Arrowsmith moderated the panel discussion, "Can Clinical Pathways Have Burnout, Too?" at Patient-Centered Oncology Care® (PCOC) 2023, and you can check out highlights from that panel here.


How can payers and providers work together to develop pathways?

I think it's really critical for payers and providers to try to work together. It's difficult on both sides, there's not always 100% trust, and I think particularly on the provider side it's logistically difficult and not a 3-week process. Often it's a several years process, but working collaboratively is really critical. A huge problem that physicians have with payer-based pathways is that feeling that you're powerless and don't have say, and if you can work collaboratively, that can change from frustration to understanding that really makes things work better.

What is the oncologist’s role in building oncology care pathways at Tennessee Oncology and OneOncology?

Our pathways program at Tennessee Oncology and OneOncology is completely physician led, so it's using disease-based experts from across OneOncology to get together, review the latest data, and make changes to the pathways as appropriate. We have a support team of pharmacists that work with us as well, but it's really the individual physicians working together who come to the final decisions about the pathways. I always think it's super important to have that strong sense of legitimacy of the pathways that people feel "these are my pathways" rather than "these are decisions foisted upon me from some unknown people."

How do practices find the compromise between developing consistent pathways and prioritizing specific practice needs?

Increasingly thinking about the issues of where pathways specifically fit in, for a long time we've talked about guidelines like the [National Comprehensive Cancer Network] guidelines, and then pathways almost as a more specific subset of that. Pathways for us are 100% clinically driven, but increasingly, an individual practice or even an individual practice and an individual payer might have some agreement for in those situations when there's clinical equipoise. There are 2 treatments that either have been studied in a head-to-head fashion and found to be similar, or more frequently, when you have 2 drugs of the same class, say, 2 immune checkpoint inhibitors that have both been studied with chemotherapy, found to be superior to chemotherapy, and those studies look pretty similar. So the physician feels either one of those drugs is probably about the same, that maybe there might be a decision to use one or the other, perhaps in a value-based way, with a payer. In those settings, we don't really change the pathways, per se, but we're working on a variety of prompts to let that physician know at the point of care that really there's one of those that might be preferred in this particular patient at this particular time.

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