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Medical World News: Managed Care Updates

Evidence-Based OncologyApril 2018
Volume 24
Issue 5

ASCO reviews clinical pathways; Flatiron Health acquired

ASCO Review Finds Clinical Pathway Programs Adhere to Guidelines

Samantha DiGrande

On February 7, 2018, the American Society of Clinical Oncology (ASCO) published1 its review of the leading oncology pathway vendors in the United States in the Journal of Oncology Practice. The report showed that overall, the prominent commercial pathway programs in the United States are aligned with ASCO’s evaluation criteria.

The report examined clinical pathways offered by 6 commercial vendors using the organization’s set of 15 interrelated criteria.2 “ASCO conducted this assessment to provide more complete information about how current pathway programs are developed, implemented, and analyzed by specific pathway vendors. Equipped with this information, the oncology community will be better able to evaluate and use these pathways in practice,” ASCO President Bruce E. Johnson, MD, FACP, FASCO, said in a statement.3

Although ASCO’s Task Force on Clinical Pathways found some differences among the oncology clinical pathways and decision support tools that were evaluated, largely due to unique vendor business models and different customers, it also discovered that all vendors met key ASCO criteria for being expert driven, patient focused, up-to-date, and comprehensive. Vendors also offered integrated decision support and provided outcomes-driven results.

However, the ASCO review found that as a group, oncology clinical pathways met fewer aspects of the criteria in terms of having clear and achievable expected outcomes and public reporting of performance metrics. This shows that as pathway programs enter the healthcare delivery system, more information should be provided about the specific cancer type the pathway is intended to cover as well as what indicates on-pathway versus off-pathway treatment. Additionally, the review found that there is a need to ensure that pathway programs offer more in-depth reporting that reflects when the provider has gone off pathway.

ASCO’s task force also evaluated the vendors’ products against the criteria for high-quality clinical pathways based on publicly available information and in collaboration with the vendors. Some vendors actually modified their processes during the review, potentially based on the ASCO criteria or as a result of interactions with task force members.

“We are encouraged to see that, by and large, prominent pathway programs are adhering to ASCO’s criteria for high-quality clinical pathways. We hope our assessment of the pathways landscape will help these programs make further refinements, with the ultimate goal of improving the care of our patients,” said the chair of ASCOs task force, Robin Zon, MD, FACP, FASCO.3


  1. 1. Daly B, Zon RT, Page RD, et al. Oncology clinical pathways: charting the landscape of pathway providers [published online February 7, 2018]. J Oncol Pract. doi: 10.1200/JOP.17.00033.
  2. 2. ASCO releases criteria for high-quality clinical pathways in oncology. American Society of Clinical Oncology website. asco.org/advocacy-policy/asco-in-action/asco-releases-criteria-high-quality-clinical-pathways-oncolo- gy?et_cid=40009433&et_rid=873267314&linkid=criteria. Published November 16, 2016. Accessed February 13, 2018.
  3. 3. ASCO examines the current oncology clinical pathways landscape [press release]. Alexandria, VA: ASCO; February 7, 2018. asco.org/about-asco/press-center/news-releases/asco-examines-current-oncology-clinical-pathways-land- scape. Accessed February 16, 2018.

Roche Acquires Flatiron Health for $1.9 Billion

Mary Caffrey

On February 15, 2018, Roche acquired Flatiron Health, a leader in oncology-focused electronic health decision-making software and data storage. Flatiron, which taps a network of community oncology practices and research centers across the country, possesses tools1 that practices need to pursue the value-based care models that Medicare and commercial payers believe are essential to rein in the escalating cost of healthcare as the population ages.

This is especially true in cancer care, and a statement2 on Roche’s acquisition touts Flatiron’s leadership as a data curator as it pursues a personalized healthcare strategy, while vowing that Flatiron will maintain its independence.

“We believe that regulatory grade real-world evidence is a key ingredient to accelerate the development of, and access to, new cancer treatments,” Daniel O’Day, CEO of Roche Pharmaceuticals, said in the statment.2 “Flatiron Health is best positioned to provide the technology and data analytics infrastructure needed not only for Roche, but for oncology research and development efforts across the entire industry.”

The statement stated that Flatiron “has worked with industry leaders and regulators to develop new standards for how real-world evidence is used in regulatory decisions,” including the creation of novel endpoints. “A key principle of this is to preserve Flatiron’s autonomy and their ability to continue providing their services to all existing and future partners,” O’Day said.

Roche made a similar move in the diabetes sector in 2017 when it acquired mySugr,3 a diabetes app with 1 million users that had earned a loyal following among those who track personal data to manage their condition.

In an interview last year with The American Journal of Managed Care®, Flatiron co-founder and CEO Nat Turner discussed the barriers to providing oncology care that the company seeks to dismantle, leading to democratization of care.4

“For access, it’s really hard, as a community practice, to attract great clinical trials. You can if you have a local affiliation with a hospital, but if you’re just a small independent practice, access to clinical research can be rough,” Turner said. Flatiron’s technology can also help independent practices stay that way, even in an era of shrinking margins and payer pressure, he said.

While Flatiron helps the smallest players, Roche touts its size as the world’s largest biotech company, with a footprint in oncology, immunology, infectious disease, ophthalmology, diabetes management, diagnostics, and central nervous system disease.

Roche already had a stake in Flatiron, and today, Turner said, “Roche has been a tremendous partner to us over the past 2 years and shares our vision for building a learning healthcare platform in oncology, ultimately designed to improve the lives of cancer patients. This important milestone will allow us to increase our investments in our provider-facing technology and our services platform, as well as our evidence-generation platform, which will remain available to the entire healthcare industry.”

Flatiron expects to keep its current business model in the deal, maintaining the segregation of patient protected health information and provider-facing life science initiatives.


  1. Fargnoli B, Holleran R, Kolodziej M. Why oncologists need technology to succeed in payment models. Am J Manag Care. 2017;23(SP5):SP196-SP198.
  2. Roche to acquire Flatiron Health to accelerate industry-wide development and delivery of breakthrough medicines for patients with cancer [press release]. New York, NY: Roche; February 15, 2018. roche.com/media/store/releases/ med-cor-2018-02-15.htm. Accessed February 16, 2018.
  3. Caffrey M. Roche acquires mySugar digital diabetes app. The American Journal of Managed Care® website. june 30, 2017. ajmc.com/newsroom/roche-acquires-mysugr-digital-diabetes-app. Accessed February 16, 2018.
  4. Nat Turner on the main barriers for Flatiron Health in providing care in oncology. The American Journal of Managed Care® website. February 15, 2018. ajmc.com/interviews/nat-turner-on-the-main-barriers-for-flatiron-health-in-provid- ing-care-in-oncology. Accessed February 15, 2018.

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