Clinical pathways were originally created to standardize cancer care and ensure patients receive the best evidence-based treatment for their disease. A divide has developed, however, between pathways that primarily serve physicians and those that cater to payers that are trying to rein in costs. Among those on the side of physicians and practices is Via Oncology, a Pittsburgh-based pathway development company whose pathways emphasize drug efficacy and toxicity rather than price, said Gordon Kuntz, Via’s senior director of strategy.
In theory, oncology pathways always consider efficacy first in guiding a drug choice, followed by toxicity. Cost is only to be used as a kind of tie-breaker between 2 or more similarly effective treatments. But some payers require doctors to use pathways that put more weight on cost or that steer them toward certain less expensive drugs and make it difficult to go off-pathway when needed.
When doctors in Via’s network create pathways, they are aware of drug costs, but Kuntz said those prices rarely contribute to their decisions. “About 5% of the time, we actually look at cost as a driver. Some payers want cost to be a more important factor, and that’s not how we operate,” he said at the World Congress 4th Annual Oncology Market Access Summit in March. Kuntz said his company has passed on opportunities to do business with payers because of their greater focus on cost. “Because it’s our philosophy—it’s in our DNA—it would be just wrong for us to develop a specific pathway for a payer,” he said.
Practices become paying members of Via’s network because they want to improve their patient outcomes through standardization of treatment, Kuntz said. Pathway programs also provide data that demonstrate a practice’s value by showing how physicians made treatment choices, he said.
This can help attract referrals, which is important for community practices and academic centers that are not part of large hospital systems. Pathways can make it easier to participate in new payment models, such as medical homes. For large practice networks, pathways can help ensure consistency of quality across many locations, he said.
Via originated at the University of Pittsburgh Medical Center and was spun off as a company in 2009. The number of physicians in its network of clients is approaching 1500 at 38 providers, including 10 academic centers, 13 hospitals, and 15 community-based practices in 27 states, Kuntz said. The clinical pathways are developed by 31 disease committees made up of physicians in the network. Most of the committees meet quarterly to review the latest research and update drug recommendations; after a meeting, it takes 4 to 6 weeks for the company to integrate any pathway changes into its software.
Unlike some other companies, Via always has a single best drug option at the end of each pathway, although it also provides an alternative treatment plan for patients who have neuropathy, in case of a drug shortage, or for other special situations, Kuntz said. As is standard in the industry, 80% of patients are expected to be treated on pathway, a quarter of whom may be assigned to the alternative scenario. Up to 20% may be off-pathway, with physicians required to explain their reasoning through Via’s software.
Kuntz said Via is unique in that it supports all 3 major oncological treatment approaches. Its pathways cover 95% of its members’ medical and radiation oncology cases and about 60% of surgical oncology. However, as with other companies, individual pathways do not integrate the 3 methods. “Today, they live a little bit independently,” he said. “We’ve talked about, how do we create a true multidisciplinary scenario?”
Part of Via’s mission is to promote clinical trials. With its pathways software, a physician enters a patient’s data and proceeds to a recommendation page that first presents relevant trials available at that practice. “The physician can’t get past that, to the standard of care, without saying either, ‘Yes, please screen this patient for trials’ or ‘No, the patient doesn’t want to be on a trial’ or ‘No, I don’t think this trial is applicable to this patient.’ And you have to say why,” Kuntz said. Patients aren’t automatically enrolled in trials, but the system can send an e-mail to a trial screener who can quickly meet with the patient. Adopting the software has helped practices increase their clinical trial accrual rates, he said.