1. Butcher, Lola

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If the term "cancer care pathway" seems to be ubiquitous already, brace yourself for the future.

Pathways... - Click to enlarge in new windowPathways

Three pathways vendors have been in the market for more than a year, and they are getting ready for company.


As insurers and policy analysts become ever more attuned to the wide variation in cancer care treatment (See "New Dartmouth Atlas Report: Geography is Destiny When It Comes to End-of-Life Cancer Care" in the 12/10/10 issue), lots of ideas for how to reduce that variation are being introduced.

Comparison of Pathwa... - Click to enlarge in new windowComparison of Pathways Development: Who Develops Pathways?
What Pathways Mean F... - Click to enlarge in new windowWhat Pathways Mean Financially for Oncologists

"I got a call last week from somebody who is developing a pathway program and was looking for ideas and advice, and another company that has their own program just came to my attention," said Bruce Cutter, MD, an oncologist and consultant to payers and practices. "Truly, every month there's another entry into this field."


At The Advisory Board Company, a health care professional services company, Allison Shimooka, Managing Director of Strategic Research, describes a philosophical divide between those who believe in "one true pathway" versus those who think that approach is overly restrictive.


"Truists would say there is no reason for clinical variation [in a pathway for a given disease state] while others would say you need to allow for physicians' preferences to some extent," she said. "They are duking it out in the market."


As pharmacy benefit managers, specialty pharmacies and others position themselves for the pathways era, look for the term "pathway" to become fuzzier, Dr. Cutter says. In some cases, he thinks the word "pathway" may become code for "enhanced utilization management."


"Their value proposition is, 'we'll figure out these pathways for you and we will work with you to have the doctors adopt these pathways,'" he said. "It varies all over the map exactly how they are planning to do it, but it is not necessarily about quality and value. It can just be about managing the drugs."


If the definition of "pathways" remains to be sorted out, so does the power dynamic related to pathways use. Some pathways vendors market to oncologists, some to payers, and some to both. Further, some oncology practices are developing their own pathways either on their own or in collaboration with other oncologists in their region or state, and working with payers to negotiate contracts related to their use.


"I feel like we're in the VHS v Betamax phase," Shimooka said.


To track the evolution of cancer care pathways, OT asked the three original vendors to submit written answers to a list of questions about how their pathways are developed, how their programs affect oncologists financially and how they avoid conflicts of interest in pathways development.


The full responses from each of the vendors appear on in the Practice Matters blog (


A summary of the vendors' responses is shown here.

How Pathways Program... - Click to enlarge in new windowHow Pathways Programs Size Up