Abstract
As the US transitions from volume- to value-based cancer care, many cancer centers and community groups have joined to share resources to deliver measurable, high-quality cancer care and clinical research with the associated high patient satisfaction, provider satisfaction, and practice health at optimal costs that are the hallmarks of value-based care. Multidisciplinary oncology care pathways are essential components of value-based care and their payment metrics. Oncology pathways are evidence-based, standardized but personalizable care plans to guide cancer care. Pathways have been developed and studied for the major medical, surgical, radiation, and supportive oncology disciplines to support decision-making, streamline care, and optimize outcomes. Implementing multidisciplinary oncology pathways can facilitate comprehensive care plans for each cancer patient throughout their cancer journey and across large multisite delivery systems. Outcomes from the delivered pathway-based care can then be evaluated against individual and population benchmarks. The complexity of adoption, implementation, and assessment of multidisciplinary oncology pathways, however, presents many challenges. We review the development and components of value-based cancer care and detail City of Hope’s (COH) academic and community-team-based approaches for implementing multidisciplinary pathways. We also describe supportive components with available results towards enterprise-wide value-based care delivery.
Highlights
Multidisciplinary Oncology Pathways Are a Foundation ofValue-Based Cancer CareWhile the majority of cancer care in the US is provided in the community setting, over the past 12 years, the organizational structure of oncology care delivery has shifted to networks of community oncologists partnered with academic centers, hospital systems, or other community practices
In 2016, a decision was made to use the VIA Oncology Pathways developed at the University of Pittsburg Medical Center (UPMC) Hillman Cancer Center ( ClinPath by Elsevier and will be referred to as such going forward) which met the criteria of the January 2015 ASCO
As with medical oncology pathways, radiation therapy pathways were piloted by the University of Pittsburgh Medical Center (UPMC) group, who led the development of the ClinPath pathways for radiation oncology based on the same principles used for the development of medical oncology pathways to standardize care for the most common radiation treatments, prioritizing efficacy toxicity costs
Summary
While the majority of cancer care in the US is provided in the community (nonacademic) setting, over the past 12 years, the organizational structure of oncology care delivery has shifted to networks of community oncologists partnered with academic centers, hospital systems, or other community practices. In response to the City of Hope Enterprise leadership prioritizing the delivery of reportable value-based oncology care, a Value Realization Project (VRP), led by a multidisciplinary group of clinicians, pharmacists, nurses, administrators, informaticists, program managers, quality, data analysts, risk and outcome experts, and our chief medical and administrative officers, was formed. This VRP group developed a Value Framework (VF). The purple arrow indicates that goals of care pathways are incorporated during active therapy as well during in advanced end of life care
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