FEATURE
Finding the Care Path of Least Resistance:
Weighing the Risks and Rewards of
Standardizing Care
Greater exploration of the “hows,” the “whys,” and
the heterogeneity of hematologic conditions in
recent years has led to greater variety of treatments available to patients with blood disorders.
These advances in care, though, have come at a
time when many health-care organizations are
trying to navigate how to provide standardized,
value-based care for patients. Clinical care paths,
sometimes going hand-in-hand with alternative
payment models, have emerged as one approach
to ensure care for hematologic malignancies is
effective – from the standpoint of both patient
outcomes and cost.
“A care path is an evidence-based (ideally)
or expert opinion–based guideline on how care
should be delivered,” David L. Longworth, MD,
chief medical officer at Lahey Health Community
Practices in Burlington, Massachusetts, and professor of medicine at Tufts University School of Medicine, explained to ASH Clinical News. “It can be a
very focused guideline around a specific procedure,
or it can be more ‘fully baked,’ meaning it covers a
clinical problem across the entire care continuum.”
“The idea behind using care paths is to standardize, to as great of an extent as possible, the
way we deliver care,” Dr. Longworth said. “With
standardization, the goal is to achieve outstanding
quality at an affordable price and eliminate unnecessary variation in treatment.”
ASHClinicalNews.org
Until recently, Dr. Longworth headed Cleveland Clinic’s Value-Based Care Steering Committee and was involved in the development of
evidence-based care paths across a variety of
disease types there.
When the Cleveland Clinic began to look into
developing clinical care paths, it reached out to
Intermountain Healthcare, a health-care organization in Salt Lake City, Utah, which Dr. Longworth
said was an early leader in developing what it
called “care process models” about 15 years ago.
“They identified chronic diseases or procedures and began to deploy multidisciplinary
teams of content experts in the delivery of care to
create systems for managing diabetes, hypertension, joint replacement surgery, and other areas,”
Dr. Longworth said. “In recent years, as valuebased care and hospital-based purchasing have
gained prominence, more and more health systems have recognized that standardization leads
to better quality care at a lower cost.”
Although originally applied to hospital readmissions or post-operative wound infections,
the use of these care paths has expanded more
recently into specialty areas including hematology
and oncology. ASH Clinical News spoke with several physicians about the effects of care paths on
patient care, and the alternative payment models
with which they can sometimes go hand-in-hand.
Standardization of Care, Reduced
Variability
How is a typical care path in the area of hematology developed? Brian J. Bolwell, MD, chairman
of the Taussig Cancer Institute and professor of
medicine at Cleveland Clinic, offered the following
example for a care path that defines the treatment
plan for patients with newly diagnosed stage 3 or 4
B-cell non-Hodgkin lymphoma: Experts at the institution get together to discuss what should be the
standard work-up of these patients, including what
”With standardization,
the goal is to achieve
outstanding quality
at an affordable price
and eliminate unnecessary variation in
treatment.”
—DAVID L. LONGWORTH, MD
ASH Clinical News
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