By Robert Truckenmiller, Senior Vice President, Market Access & Customer Solutions, EMD Serono
This year, it is estimated that over 1.7 million people will be diagnosed with cancer in the United States.1 And while great strides have been made in cancer prevention, detection, and treatment, some of these advances in cancer care have been so novel that they have also led to new challenges for payers. In fact, among health plans surveyed for the 14th Annual EMD Serono Specialty DigestTM, 71% said that managing oncology drugs and services was one of their top five challenges.
An important aspect of managing cancer treatment is the use of clinical pathways and other evidence-based guidelines. Clinical pathways are multidisciplinary care plans that guide the sequencing of treatment2, and are widely used to inform oncology management in the US. Furthermore, payers are increasingly encouraging oncologists to comply with pathway recommendations3 based on their potential to help improve patient outcomes.
According to the Specialty Digest — which collected input from 59 commercial health plans in 2017, representing more than 76 million covered lives — 42% of health plans use at least one clinical pathway in oncology treatment — in line with results seen in the previous edition of the Specialty Digest. Interestingly, however, this year’s edition saw a dramatic shift in how these pathways are created.
Today, 84% of health plans collaborate with oncologists to develop cancer treatment pathways — compared to only 38% in the year prior. Respondents preferred the collaborative approach over using third-party pathways (28%), creating proprietary pathways internally (24%), or relying on oncologists to develop their own pathways (12%).
What was the rationale behind this drastic change? The simple answer: greater collaboration is typically viewed as more beneficial. Payers are realizing that connecting with the experts — specifically, oncologists on the ground who see cancer patients on a daily basis — helps them to better understand how to manage oncology drugs and services as part of their health plans. This more collaborative approach makes sense and is also in line with recent recommendations from the American Society of Clinical Oncology (ASCO), which urges all stakeholders to work together to ensure treatment pathways promote high-quality patient care.4
Companies can also play a role in helping to ensure that treatment pathways are optimally designed to provide the best course of care for cancer patients. EMD Serono is committed to improving the patient experience while ensuring physicians the ability to optimally care for patients, improve patient outcomes, and maintain patient choice.
EMD Serono’s Specialty Digest is an annual industry resource that provides market data on health insurance plans’ management of biopharmaceuticals and identifies common trends across plans. Download a copy of the 14th Edition EMD Serono Specialty Digest™ for more insights into how health plans are tackling the challenges of today and planning for the future, particularly in the oncology space.
1American Cancer Society. Cancer Facts & Figures 2018. Available at https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2018/cancer-facts-and-figures-2018.pdf. Accessed May 10, 2018.
2Kinsman L, Rotter T, James E, Snow P, Willis J. What is a clinical pathway? Development of a definition to inform the debate. BMC Medicine. 2010;8:31.
3Clinical Pathways: Overview of Current Practices and Potential Implications for Patients, Payers, and Providers. Avalere Health. July 2015.
4American Society of Clinical Oncology Criteria for High-Quality Clinical Pathways in Oncology. 2016. https://www.asco.org/sites/new-www.asco.org/files/content-files/blog-release/documents/2016-ASCO-Criteria-High-Quality-Pathways.pdf