By Scott Filosi, Global Head of Market Access & Pricing, Merck KGaA, Darmstadt, Germany
n a gradual transition away from relying on direct oncologist insights and collaborations with oncologists, specialty pharmaceutical health plans are now using broader, more evidence-based approaches to determine the most appropriate standardized processes for specific cancer diagnoses.
These standardized processes, “oncology pathways”, are based on best practices specific to a patient’s diagnosis and used for managing care for patients with cancer. Oncology pathways are becoming more widely used. Thirty-six percent of managed healthcare plans surveyed currently use them and another 24% are planning to implement them in the next 12 months, according to the recently released 13th edition of the EMD Serono Specialty Digest™.
The EMD Serono Specialty Digest outlines the results of a survey of 58 commercial health plans representing 173 million covered lives. Over the last thirteen years, it has been utilized as a valuable industry tool to help understand the challenges facing healthcare plan managers. Among the top challenges identified by respondents is “managing oncology drugs and services” with 79% of respondents identifying this as their top challenge, which is unchanged from last year.
In addition to an increase in the use of oncology pathways, the survey also found that health plans are changing how they create these pathways, with 19% of managed care organizations having altered their methods of determining how they create these standardized processes during the past 2 – 3 years. Changes in the creation of these pathways have been attributed to the need to be more in line with two healthcare industry trends: evidence-based guidelines and the addition of a larger interdisciplinary team to drive pathways. There has been a growing trend across the entire industry to leverage the enormous body of peer-reviewed data as the core of all standardized guidelines. In addition, managed care organizations are collaborating more with oncologists to develop these pathways versus solely relying on oncologists to create oncology pathways (down to 5% from 14% last year).
Additionally, as interdisciplinary teams become more common, obtaining the viewpoint of other specialists may also be valuable. Modern day patient care is adapting to integrate a more complete range of health professionals who can work together to manage the whole individuals. While this trend is occurring across the whole healthcare industry, it is particularly valuable in oncology treatment due to how complex cancer care can be. A number of healthcare providers are necessary to support each cancer patient through the diagnosis and treatment processes, and the interdisciplinary team approach allows for improved communication and coordination of care. This approach also offers better adherence to evidence-based guidelines,[i],[ii],[iii] and higher levels of patient satisfaction.[iv],[v]
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[iii] Conron M, Phuah S, Steinfort D, et al. Analysis of multidisciplinary lung cancer practice. Intern Med J. 2007;37(1):18–25. doi:10.1111/j.1445-5994.2006.01237.x. [PubMed]
[iv] Rajasekaran Ab, Silvey D, Leung B, et al. Effect of a multidisciplinary lung investigation day on a rapid access lung cancer service. Postgrad Med J. 2006;82:414–416. doi:10.1136/pgmj.2005.041699. [PMC free article] [PubMed]
[v] Bjegovich-Weidman M, Haid M, Kumar S, et al. Establishing a community- based lung cancer MD clinic as part of a large integrated health care system: Aurora Health Care. J Oncol Practice. 2010;6(6):e27–e30. doi:10.1200/JOP.2010.000022. [PMC free article] [PubMed]