News and Events

Engaging Cancer Patients in Treatment Decision-Making

by Dr. Jim “Woody” Woodburn, MD MS

I recently read an excellent article and interview in the Journal of Clinical Pathways with Ellen Miller Sonet, chief strategy, and policy officer, CancerCare. It discusses the critical need to involve patients with cancer in treatment decision-making.

Variables cancer patients consider when comparing cancer treatment options

Summary 

Patients and their families have for years sought information on the outcomes of clinical therapies, side effects, out-of-pocket costs and a host of other personal and family-oriented questions to better inform their decisions on the cancer care they wish to receive.  In addition, there are resources that are available by the patient’s health plan, provider organization, community services, etc. that are hard to find or completely unknown to the patient. Add to all of this the remarkable pace of new clinical wisdom and cancer therapy protocols and you can understand why we need a methodology to be equal to the tidal wave of medical information, best practices and evolving benefits a cancer patient needs to understand.

I think Ellen Miller Sonet is correct. Applied Pathways’ position is physicians and patients should be able to weigh treatment options based on a combination of the best clinical evidence available and patient preferences.

A Solution

Technology can help make this possible. Applied Pathways provides the technological infrastructure to rapidly create, improve, and deliver highly contextualized patient-centered knowledge to better inform the patient and caregivers with evidence-based clinical, financial and social impacts of treatment options.  

Organizations like Mayo Clinic, AIM Specialty Health, and InformedDNA use this state-of-the-art visual programming and rules engine technology to continuously improve and deliver information at the point of time and point of need to people throughout the healthcare ecosystem. This system allows clinicians and experts to build assessments that ask the right questions and then build the logic to get to an answer or recommendation to the patient that builds upon and integrates needs and wishes in the critical dimensions of cost, side effects, efficacy, quality of life, logistics, etc.

Enabling Multi-Criteria Decision Analysis

Any one of the dimensions of consideration listed above is significantly complex in and of itself individually. Using a method such as Multi-Criteria Decision Analysis where all of the dimensions are weighted on a sliding scale based on the individual patient situation and preferences and then rolled up into summative conclusion as the best-fit clinical treatment regimen is a herculean task.  It requires overlapping and integrating dynamic answers to questions from an unlimited number of data sources that change the end result. Let me tell you how it works.

The approach to solving for this multivariate calculation is to break apart the dimensions into separate sets of assessments, empirically create a weighted score for each and then aggregate the results with specific recommendations based on the collective results.  The Applied Pathways platform uses this model of subset assessments and rules to interpret answer sets (we call them algorithms) and, using this type of subroutine programming model, uses overarching or mother algorithms to roll up complex sets into a cohesive and understandable report.

This set of assessments works well for a subjective and qualitative inquiry into patient and family member preferences, wishes and goals.  Two other dimensions, cost of care and clinical regimen/treatment plan choices, require access to other complex, dynamic and often times unclear data sets.

Cost of Care

Cost of care requires access to the health insurance benefits of the patient including plan specific information such as co-insurance, deductibles, in-network vs. out-of-network costs, and pharmacy benefits.  Patient out-of-pocket cost advice also needs to have access to current annual expenses already paid or accumulated and may cross annual coverage dates. These types of data collection rules can be built with the Applied Pathways visual programming and rules engine technology and our data integration services allow for straightforward data exchange with other systems in healthcare and elsewhere.

Clinical Regimen and Treatment Plan Choices

For the clinical regimen and treatment path options, one of our clients (AIM Specialty Health) has entire teams of clinical experts, informatics experts, analysts and coders who over many years have built excellent, evidence-based, physician-led clinical pathway algorithms that allow for a set of recommendations on the most appropriate treatment routines based upon precise clinical information data inputs.  These highly sophisticated rule sets are built for other clinical decision support applications such as what radiology imaging test is most appropriate but can handle oncology-specific decision support just as easily.

Final Thoughts

Cancer patients, their families, and caregivers deserve better information in order to make the best decisions possible in the challenging medical, financial, social and personal situations they face.  Technology can facilitate and simplify the assessments, inquiry, and display of options available to the patient when driven by rules created by experts and evidence.

Read MoreEngaging Cancer Patients in Treatment Decision-Making

The right time. The right partner.

Applied Pathways announced some exciting news this morning: we are now a wholly-owned subsidiary of AIM Specialty Health, one of the leading specialty benefits management providers in the United States. And our authoring and rules engine technology, recently certified as a Clinical Decision Support Mechanism by the Center for Medicare and Medicaid Services, has long been core to its offerings.

The Applied Pathways leadership team has been in this industry for a long time and we have been involved in literally dozens of company combinations. We want to share why we are excited about this one in particular.

First, healthcare is suffering from a knowledge problem (shout out to Dr. Atul Gwande of the Checklist Manifesto and his interview with Ezra Klein from September 2016). It’s not that we don’t know what to do, it’s that we don’t do it or aren’t aware of it.  I am not a clinician, so admit my own knowledge gap, but the research seems fairly compelling that we both over and under care for people. There are many reasons why but most relate to shortcomings in today’s systems and tools.

Second, costs are exploding with minimal, if any, impact on quality by any macro metric. This is driven by variance in decision-making or an over-reliance on gut and judgement versus what clinical evidence tells us is the best approach to take. We all know we can do better but we simply don’t know how. Many thought electronic health records were going to be the answer, but we now know they’re only a part of the solution.

Third, knowledge is changing so quickly, complexity continues to grow at an astonishing rate, and new tools like AI and deep learning come along promising to solve all of our problems. Who isn’t struggling to manage multiple EHR platform, seemingly infinite versions of medical policy, too few IT resources to keep back-end systems current, and a strong desire to use the latest cool thing?

Applied Pathways is helping many organizations solve this problem TODAY. It’s what drew our leadership team to Applied Pathways over the past 24 months: The ability to deliver evidence- based insight, appropriately and seamlessly into the workflow without the overhead of solutions that create alert fatigue and screen “whack a mole”. And it’s what will continue to drive us. It’s why we sought CDSM certification from CMS and it’s why we have been working with AIM behind the scenes as a client for more than 2 years to provide solutions with clinical and economic value. We want to help clinicians, payers, and other tech services companies make better, more appropriate decisions that help patients and the bottom line.

What does this have to do with AIM? Well, AIM Specialty Health, shares our vision for delivering clinical decision support into the workflow at the point of care. Coming together with them gives us with the single best opportunity to drive adoption of our Curion® platform and position our employees for long-term success. For our collective clients and prospects it means more meaningful solutions that deliver real, measurable value.  

We’re already collaborating on an automated prior authorization solution that will allow doctors to get approval on orders at the point of care. It will ensure that patients get the care they need while saving time and money.   

The future for healthcare and for Applied Pathways is brighter today than it was yesterday and we can’t wait to talk to you about it.

Steve Lefar, CEO of Applied Pathways       By Steve Lefar, CEO of Applied Pathways

 

Read MoreThe right time. The right partner.

AIM Specialty Health® (AIM) Acquires Applied Pathways to Accelerate Delivery of Technology-Enabled, Evidence-Based Clinical Solutions for Payers and Providers

FOR IMMEDIATE RELEASE

Chicago, IL, August 17, 2017 – AIM Specialty Health, a leading specialty benefits management company, has acquired Applied Pathways, a leader in visual authoring and rules engine software for health care. AIM currently leverages Applied Pathways’ software solutions to simplify, encode and utilize complex clinical content into a standardized, repeatable, evidence-based system for making decisions within AIM clinical programs.

Together the companies have deep experience in both the payer and provider markets.  For more than two decades, AIM has been a leader in solutions for clinical review, provider collaboration and member engagement. In addition to its work with AIM, Applied Pathways’ clients have used its sophisticated visual authoring and rules engine platform to inject clinical knowledge into their applications, such as electronic health records, patient portals, nurse triage call centers, and other clinical applications.  

Combined, the companies offer an industry-leading approach to both clinical decision support and clinical appropriateness review, supporting providers and health plans. Their technology-enabled and evidence-based solutions mean better clinical decision support tools that increase the quality, efficiency and value of health care decisions for patients, physicians, and payers.

In addition, both AIM and Applied Pathways are qualified participants in the CMS Appropriate Use Criteria Program addressing outpatient advanced imaging services. The program, part of the Protecting Access to Medicare Act, mandates that providers use CMS-approved clinical decision support criteria, through a qualified mechanism, that documents the appropriateness of a high-tech, diagnostic imaging order to receive full reimbursement for Medicare fee-for-service beneficiaries effective January 1, 2019.

“Our companies share a common goal to promote evidence-based medicine and ensure that services are appropriate, safe and affordable,” said Brandon Cady, president and CEO of AIM. “Together, AIM and Applied Pathways support greater provider collaboration with highly automated tools that enhance clinical value for physicians and health plans. This marks another important investment in innovation for our customers.”

Steve Lefar, CEO of Applied Pathways, said, “We are clearly aligned in our mutual vision to make it easier for physicians and other care givers to measurably reduce variance and improve quality of care. Joining forces with AIM gives us new opportunities to drive even more meaningful solutions that deliver real, measurable value to our expanding set of customers.”

 

About AIM 
AIM Specialty Health® provides clinical solutions that drive appropriate, safe and affordable care. Serving more than 50 million members across 50 states, D.C. and US territories, AIM promotes optimal care through use of evidence-based clinical guidelines and real-time decision support for both providers and their patients. The AIM platform delivers significant cost-of-care savings across an expanding set of clinical domains including radiology, cardiology, oncology, specialty drugs, sleep medicine, musculoskeletal and genetic testing. AIM is a wholly-owned subsidiary of Anthem, Inc. (ANTM). For more information, visit www.aimspecialtyhealth.com and www.aiminform.com.

About Applied Pathways
Applied Pathways is focused on reducing the unwanted variance in healthcare that leads to unnecessary spending without positively impacting quality of care. Our visual authoring, rules engine software, and workflow specific EHR embeddable applications simplify the process of encoding and utilizing clinical knowledge and institutional best practices to deliver a standardized, repeatable system for making decisions across the clinical continuum. To learn more visit appliedpathways.com or follow us on Twitter at @appliedpathways.

Contact:                      

AIM Specialty Health
Lori McLaughlin 317.407.7403
Lori.McLaughlin@anthem.com

Read MoreAIM Specialty Health® (AIM) Acquires Applied Pathways to Accelerate Delivery of Technology-Enabled, Evidence-Based Clinical Solutions for Payers and Providers