Kathleen Lokay Makes the Case for Cancer Treatment Pathways

Nobody wants “cookbook medicine,” according to Kathleen Lokay, president and CEO of Via Oncology. To many in healthcare, however, treatment pathways represent just that: a form of standardization that takes care out of a provider’s hands.

That may rub some people the wrong way, she said, but it shouldn’t.

At the Patient-Centered Oncology Care meeting in Philadelphia, Lokay argued that it’s important for oncologists and healthcare leaders to understand that treatment pathways are not a rigid recipe, but rather a key decision support model meant to drive down unwanted variability.

She painted pathways as increasingly important tools for ensuring value and quality in a changing healthcare landscape. The brunt of financial pressure is shifting in healthcare. While it used to fall mostly on payers, Lokay described a “new world order” in which payers are passing the burden of lowering costs onto providers themselves. Increased scrutiny, foundational changes under the Affordable Care Act, and the looming weight of MACRA all contribute to this shift.

Pathway utilization can help keep cancer patients in a health system’s network throughout treatment. If good outcomes are achieved, they can potentially boost referrals. Cancer care is often being handled by accountable care organizations (ACOs), and referrals are more dependent on results than social or professional connections between providers, as they may have been in the past. Providers must prove quality and value to an ACO, since “their referrals to you can really make or break their budget,” she said.

They can also promote clinical trials, she said, and create risk assessments to keep payers informed and guarantee that patients are correctly reimbursed for their care. Plus, she said, pathways can be flexible.

Her company, Via, began as a project in the University of Pittsburgh Hillman Cancer Center before it was spun out on its own as a commercial product. The company develops its pathways through a series of physician-led committees throughout the country, making the decision support that they provide more interactive and less prescriptive.

“We’ve really had to learn how to herd cats. As committees get larger and larger, we have some diversity of opinions,” she said. “As the science has gotten more complex, we’ve had to learn that pathways have to be much more nimble. What may be second-line for one patient may not be second-line for another.”

According to Lokay, Via has learned over time not to be too rigid in its recommendations, and to incorporate evolving concepts like precision medicine and cost considerations over time.

Pathway determination depends heavily on IT infrastructure. Decision support software demands a content authoring tool that can allow for updates and customizations, so new recommendations can be made in real time and pushed out to all physicians in a network. Interoperability, Lokay said, is another critical aspect of decision support.

“In a perfect world, the decision support would just be naturally in the EMR,” she said. “There are some great aspirations for that, but it’s also very challenging.” While her group tries its best with what exists, she says the lack of interoperability is still a complicating factor.

Lokay sees pathways beginning to make important inroads in the treatment of most cancers, and their usefulness evolving over time. She closed her speech by predicting that evolution to cover other disciplines, besides oncology, that are vital to the care of cancer patients. She also believes that quality-adjusted life years (QALY) will soon become an important metric in pathway development.

“Our biggest competitor is delay,” she said, indicating that resistance to adoption was the biggest sticking point for providers. Despite the value that pathways bring, however, Lokay still cautions against their misuse. At the end of the day, she said, “Treat the patient, not the pathway.”