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A SINGLE ROAD FOR ALL: WHY CLINICAL PATHWAYS BENEFIT PATIENTS, DOCTORS AND INSURERS

It’s often quoted that life is a journey, but this same concept is now playing a major role in a healthcare revolution that has been underway for several decades.

Clinical pathways.

Since the 1980s, clinical pathways have been used globally as one of the key methods of managing healthcare quality. In short, it puts the focus on a patient’s entire journey through their medical care rather than separating out each different speciality that the patient may encounter. And by establishing typical pathways for various health conditions, it’s possible to measure medical professionals’ decisions against an established ‘best practice’, as well as expected patient results for each stage.

In a study published by The National Center for Biotechnology, it was recorded that as far back as 2003 there was 80% implementation of clinical pathways in US hospitals.

These pathways have delivered benefits to both patients, medical professionals and insurers – structured, multidisciplinary care plans each containing detailed steps for patients with specific clinical problems.

By using this systematic evidence-based guidance, healthcare professionals can make consistent, well-informed decisions on what clinical care is appropriate. And it has been very successful: These steps have seen a reduction in the variability of clinical care which has improved the healthcare outcome for the patient, including length of time spent in hospital and hospital expenses. It also translates into cost savings for healthcare companies and insurers.

 

Clinical pathways: The cancer example

These pathway protocols are of particular importance in the field of oncology as cancer care is constantly changing with new therapies and new biomarkers. With approximately 200 forms of cancer, an oncologist may treat many different types of the disease and it can be difficult to remain up-to-date with the constant changes in cancer knowledge.

Clinical pathways remedy this problem, providing one updated authoritative source against which the physician can evaluate the journey of his or her patient. It means ‘best practice’ is always at their fingertips.

So let’s look at some numbers: A 2014 paper in the American Journal of Managed Care estimated that medical costs associated with cancer care in the US will increase to more than $173 billion USD per year by 2020. Let that number sink in for a moment. Now consider this: A 2010 study in the American Society of Clinical Oncology showed that chemotherapy costs were 37% lower for patients on a clinical pathway versus those who were not.

Imagine if these kinds of savings could be gained across the board of cancer treatment – indeed across all disease treatments with increased clinical pathway implementation here in the UAE.

A 2010 study in the American Society of
Clinical Oncology showed that chemotherapy
costs were 37% lower for patients on a clinical
pathway versus those who were not.

It would certainly have a major impact in our region where cancer accounted for 10% of all deaths in 2010 with this number projected to double by 2020 – according to a study published in 2013, funded by the National Research Foundation in the UAE.

Benefits of clinical pathways

Having established pathways for a variety of conditions, providers are able to offer a series of protocols that aim to improve the continuity and coordination of care across different disciplines and sectors.

Once a clinical pathway is implemented into a care programme, efficiencies can be driven in a number of ways that provide numerous benefits:

  • Introduction of evidence-based medicine and clinical guidelines: As touched on earlier, well-researched support given to physicians by physicians is vital to ongoing efficiency and consistency of care.
  • Better forecasting for insurers: Clinical pathways that record results and expenses by providers can enable payer actuaries to use this information to forecast health risk and subsequently design health plans – either as a tiered or modular approach. This could deliver a value solution for health plan funding levels.
  • Control over costs: Standardisation of care means payers have a greater understanding of the associated expenses and how to manage them.
  • Increase efficiencies: All parties benefit from increased efficiencies – the patient is likely to spend a shorter time in hospital, so less expense for the insurance company involved.
  • Clinical effectiveness and risk management: A tried-and-tested research and evidence-based process to promote efficiency, reduce risk of clinical error, and remove pressure on doctors from pharmaceutical sales reps as pathways may have pre-determined drug prescriptions.
  • Support collaboration between payers and providers: Having good lines of communication between involved parties will further drive efficiencies, and can lead to better collective understanding of each stakeholder’s position.
  • Improve multidisciplinary communication, teamwork and care planning: By sharing ‘best practice’ and cross-field findings, consistency across different treatments leads to better patient health outcome and lower cost.
  • Provide explicit and well-defined standards for care: Clarity on the expected standard of care will define the process of forming effective and efficient care plans.
  • Reduction of readmissions: The delivery of effective care and a tried-and-tested treatment programme will reduce the rate of readmissions and associated costs.
  • Communicate with local provider community to develop appropriate guidelines: One size does not necessarily fit all, so clinical pathways allow cooperation with the local provider to ensure the clinical pathway fits the local market.
  • Savings for insurance companies: The cost to the healthcare insurer can be reduced, creating a more efficient operating model that puts them in an excellent position to win more managed care contracts.

The bottom (and top) line

Developing and implementing comprehensive clinical pathways is a proven way to combine quality care for patients, a structure of shared knowledge for physicians, and the potential for incredible cost efficiency for insurers.

Now and in the future.

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Inova care is an industry leading consulting and health care administration company specializing in managed care, clinical pathways and cost containment solutions for corporations and insurance companies.

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