Akshay Kamath, Daniel Colacurcio, and Sophia Tan

In 2024, the FDA issued over 60 oncology approvals, sustaining the high bar set by the agency in recent years. While encouraging, this influx of novel products and nuanced clinical data leaves generalist oncologists grappling with which regimens to keep in their treatment arsenal.

To help navigate this complexity, clinical pathways have stepped in to help standardize clinical decision-making across tumor types—reducing costs, integrating work-up guidance, and aligning with value-based care goals. Still, they remain costly, require dedicated personnel, and need frequent updates to remain relevant, making adoption challenging for smaller, resource-scarce community practices.

Despite these hurdles, pathways are gaining traction in community oncology. What’s driving this shift?

Practice Aggregators: A Catalyst for Pathways Adoption

In the past year, practice aggregators such as OneOncology have fueled the growing exposure of pathways in community oncology, rapidly acquiring oncology clinics and standardizing decision support tools across their networks. Pathways have become one of those critical tools to ensure clinical consistency, improve quality metrics, and strengthen contract negotiations, allowing aggregators to exert greater top-down control over treatment decisions. Over time, members of these aggregators have transitioned to standardized EMRs, piloted aggregators’ pathways in key indications, and, in some cases, promoted pathways adherence via incentives and penalties. Yet, the evolution of pathways within aggregators remains diverse, shaped by varying levels of practice autonomy and differing standardization priorities, as seen in the chart below.

As these unique practice aggregator models continue their expansion across independent practices, it follows that their pathways programs will remain a strategic element supporting new therapy adoption, biomarker testing visibility, and top-down clinical standardization, foreshadowing their potential to become evidence-generation engines.

Beyond Aggregators: Other Forces Driving Pathways Adoption in Practices

While practice aggregators will likely continue to be the largest source of pathways activation in the community setting, other forces may also accelerate their adoption in the coming years:

  • Growing Academically-Developed Pathways Interest: Large, elite academic centers, such as Dana-Farber Cancer Institute, are leveraging their sphere of influence to expand pathways reach to select practices, shaping decision-making beyond their institution.
  • Greater Customizable Platform Options: Platforms such as Flatiron Assist provide NCCN-based pathways templates, and while building and maintaining a pathways program is no small investment, this makes it simpler for community accounts to build their own internal pathways solutions and shift existing content from loose PDF-based formats to user-friendly, scalable systems.
  • Increasing Provider Consolidation: Naturally, mergers and acquisitions of oncology practices has driven the harmonization of clinical decision-support tools, in many cases resulting in the acquired entity adopting pathways from the absorbing entity.
  • Expansion Into Adjacent Specialties: Oncology pathways are making inroads into therapeutically-adjacent community clinics. Specifically, urology practices are just beginning to build in oncology pathways, among other access levers, to assist with prescribing standardization.

Pathways Alternatives

Not all community oncology practices have the resources or support to invest in full-fledged pathways programs, but many are exploring alternative models that offer standardization without the heavy lift:

  • Payer Pathways Integration: Some practices are embedding existing payer pathways recommendations into their EMR workflow. One community practice piloted an approach where their EMR surfaced UHC Cancer Therapy Pathways recommendations at the top of the treatment selection screen, allowing HCPs to more naturally select preferred regimens without imposing strict adherence requirements. This approach enabled them to test buy-in, attain financial incentives and electronic prior authorizations from UHC, and avoid costly EMR transitions.
  • “Pseudo”-Pathways Users: In lieu of formal pathways, some practices use preferred regimen lists or sophisticated formularies to drive evidence-based, cost-effective prescribing while avoiding the operational burden of pathways governance. Although these models may lack the same line of therapy or biomarker specificity as traditional pathways, they permit increased scrutiny on product use in priority classes, helping monitor clinical variation without nearing the infrastructural lift of a formal program.
  • AI-Driven Decision Support Systems: Emerging AI-driven clinical decision support tools may increasingly fill the gap for practices that want the insights of a pathways program without the rigidity of a formal program. Companies like Tempus have been developing machine learning algorithms to pinpoint deviations from care guidelines in select tumor types, serving a dynamic role in minimizing prescribing variation without significant practice-level overhauls.

As practices continue to consolidate, these alternative models may also gain traction and should not be overlooked in a holistic engagement strategy.

Why This Matters for Manufacturers

Ultimately, pathways adoption in the community is growing but remains fragmented, shaped by varying developer models, standardization philosophies, and degrees of implementation. For manufacturers, this presents both a challenge and an opportunity. Successfully engaging in the pathways channel requires a nuanced understanding of who these groups are, how they influence prescribing patterns across a growing user base, and how they are uniquely positioned to evolve in the coming years.

Pathways offer a direct line to large networks of affiliated community oncologists, alongside a new generation of system-level, cross-functional decision-makers, making them a powerful channel for amplifying new clinical data. However, engagement must be executed tactfully and with an acute awareness of program-level decision-making drivers.

As standardization efforts continue, manufacturer teams that proactively navigate this landscape can better position their therapies for adoption in community oncology.

Find out how The Dedham Group’s expertise can improve your pathways strategies. Contact us.

 

About the Authors

Akshay Kamath is a Principal at The Dedham Group. E-mail him at akshay.kamath@dedhamgroup.com.
Daniel Colacurcio is an Associate Partner at The Dedham Group. E-mail him at daniel.colacurcio@dedhamgroup.com.
Sophia Tan is a Managing Partner at The Dedham Group. E-mail her at sophia.tan@dedhamgroup.com.