Segment 4 - Payer Panel Pathway Recommendations

Dr Sonnad asked panelists about the participants on payer panels who determine the cost-effectiveness of pathways.

Dr Sonnad asked panelists about the participants on payer panels who determine the cost-effectiveness of pathways.

Dr Malin said WellPoint uses an internal team of oncologists and pharmacists who collaborate on pathway recommendations. They also utilize an external advisory group of oncologists from community practices and academic centers who review the organization's outcome summaries and evidence of proposed pathways.

“We also make our pathways available on the Web so anyone can download them and there’s an e-mail address as well on the pathways themselves when you download them — any provider can provide feedback to us about the pathways,” Dr Malin said. They will monitor this feedback to determine whether certain patients may not require a pathway.

Dr Yu said that there should be ongoing and regular reviews of pathway guidelines, if they’re not already established. These are useful to determine variations and changes in pathway regimens.