Segment 8: Pathways as a Means to Deliver High-Value Care

Expanding the definition of "value" beyond cost, Robert Dubois, MD, PhD, emphasized that clinical pathways need more dynamic quality metrics that provide more than just a snapshot of a patient's performance.

The discussion then moved on to value. Surabhi Dangi-Garimella, PhD, asked the panelists whether clinical pathways can help ensure patients receive high-value care.

Operating on its technical definition where “value” considers both efficacy and cost, Blase Polite, MD, MPP, explained that pathways offer the ability to say “don’t penalize me for doing the right thing for the right patient at the right time.” Being able to go off-pathway allows physicians to avoid therapies with little efficacy but high cost, and decide what is appropriate for the patient.

But if going off-pathway becomes the pattern of care, this is unacceptable, Dr Polite pointed out. Consensus is that pathways are aiming for 80%—not 100% and not 50-60% either.

Pathways ensure that physicians, in a world of bundled payments and alternative payment models, are not penalized for choosing an expensive therapy that makes complete sense for the patient in front of them, Dr Polite said.

Robert Dubois, MD, PhD, however, defined “value” differently, describing it as the benefit a patient derives at what cost. The exact value of pathways is difficult to determine, he said, because pathways are based on a string of pieces of evidence that are essentially just a snapshot. “High value means that the patients are doing well. We assume, based on the snapshots of evidence, that the patients are going to do well,” Dr Dubois said. He however questions whether we currently have the quality measure infrastructure that would ascertain a patient performed better when on a pre-defined treatment pathway.