Understanding “clinical pathways” and cancer treatment

by Linda House and Lauren Barnes, Senior Vice President, Avalere

As the numbers of cancer survivors continue to increase, the focus of the U.S. health care system is shifting towards the quality of care patients receive. As a result, new strategies are changing the way cancer care is delivered and paid for by insurers like Medicare and private plans.

One example is the term “clinical pathways.” A clinical pathway is a plan of care the health care team is encouraged to follow when making treatment decisions about an individual.  Most clinical pathways are based on the results of clinical trials and are also referred to as evidence-based treatment recommendations. Government payers like Medicare and Medicaid as well as commercial insurance plans are increasingly turning to clinical pathways in an attempt to reduce errors, reduce costs and improve quality of care.

If you or a loved one is currently receiving treatment for cancer, your health care team may be following a clinical pathway for your treatment. As you have treatment decision conversations with your health care team, it may be helpful to discuss multiple treatment options if they are available. As a part of the discussion, you might consider asking the team whether or not the option is a part of a clinical pathway, what types of clinical trials the treatment was tested in, what the overall cost of the treatment is both to you and to your insurance provider, the financial incentive for the provider to follow a particular pathway and, most importantly, whether or not the option meets your goals of therapy for both effectiveness and side effect profiles.

For more information about tools to help with these discussions, the Cancer Support Community has created Open to Options, a treatment decision counseling program designed to help you create a personalized list of questions to discuss with your health care team.  For more information about Open to Options, please visit www.cancersupportcommunity.org/open2options or call 1-888-793-9355.

For more information on Avalere Health, go to www.avalerehealth.net.


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