Putting Patients at the Center of the Clinical Pathways Debate

Conversations and healthy debate about issues facing our industry and the health care system are critical to addressing some of today’s challenges and opportunities. The Catalyst welcomes guest contributors including patients, stakeholders, innovators and others to share their perspectives and point of view. Like in our Conversations series, views represented here may not be those of PhRMA, though they are no less key to a healthy dialogue on issues in health care today. 

To continue the dialogue about clinical pathways and what they mean for treatment options, we’re pleased to host a guest blog from Alan Balch, chief executive officer, National Patient Advocate Foundation.

Patient care is complex and there are competing schools of thought to consider. Should personalized medicine reign supreme? Is a standard of care better to oversee quality and control costs?

Clinical pathways sit at the center of this debate, although I don’t see the two ideas as mutually exclusive. Critics coin clinical pathways as a “cookie-cutter” approach that can hinder the personalization of patient care, and supporters consider them an important tool to reduce errors and cost, while increasing quality and efficiency. Whichever side you’re on, it’s important to keep the patient at the center of the discussion. 

Clinical pathways can provide a detailed roadmap with essential steps for patient care based on clinical guidelines — spanning from diagnosis to treatment to monitoring.  The extent to which pathways promote or impede patient-centered care depends greatly upon the design of the pathway and the extent to which it is deployed in a manner that supports clinical judgment.  Thus, pathways should be judged based on how they are put to use in a clinical setting and whether or not they are inherently comprehensive enough to support personalized medicine. 

From the patient advocate perspective, the use of properly designed clinical pathways provide opportunities to improve care by enabling treating physicians to navigate their patients through various health care decisions, including clinical trials, based on different safety and effectiveness profiles as well as cost considerations. This will lead to clinical decisions that meet the unique needs of an individual patient. But, pathways can also pose challenges. A clinical pathway may be based too heavily on parameters associated with the “average patient” and cost containment and fewer options.  This approach will leave little room for tailoring to individual needs thereby, contradicting a personalized medicine approach.

As conversations around the use of clinical pathways continue, it’s important to ensure the process is designed to optimize and personalize treatment protocols for each patient based on individual needs and their physician’s clinical judgment — not the financial interests of health care companies

Some pathways, for example, try to pigeonhole physicians into prescribing a limited set of therapies that are preselected by insurance companies, which may hinder patient access to more effective treatments. This limited approach more closely resembles common techniques payers use, like step therapy or “fail first” requirements, which regulate how a patient gets a medication — particularly more expensive ones — to control costs.

An important consideration is who is actually developing clinical pathways. Ideally, it’s the experts in the provision of health care (i.e., medical practitioners) who should be charged with developing and implementing pathways, with clear mechanisms for involving the recipients of that care (i.e., patients and patient advocates) throughout the pathway development process. Well-designed pathways will support shared decision making and allow patients to express their preferences for how to individualize their care, leading to a personalized treatment plan. Patients need to have confidence and faith that pathways will not simply be a hidden tool to steer them to a limited range of treatment options preselected by their insurance provider. Ultimately, the answer to patient involvement is simple: give them information. They deserve no less.

For more information about The National Patient Advocate Foundation’s (NPAF) position on clinical pathways, check out their new white paper here.