HSM interviewed 18 Medical Directors from a mix of national and regional health plans serving commercial and Medicare populations.
We learned that, in the absence of comprehensive payment reform, payers are using a variety of tactics guided by different philosophies:
- Oncology pathways are implemented by some payers. But use of this approach appears to be market-specific: payers who are successful at implementing pathways typically have significant market share, work collaboratively with the physician community (or operate in a physician staff model), and have the infrastructure that enables and supports pathway implementation (see Table 1).
- Those who have chosen not to implement pathways suggest they expect either to follow the early adopters or “piggy-back” on their competitors’ investment in getting physicians to standardize their treatment approaches.