Balancing Oncology Pathways, Financial Incentives, and Shared Savings to Advance Value-Based Care

Key Takeaways: 

• At Clinical Pathways Congress (CPC) 2026, panelists discussed how clinician-led formularies, clinical pathways, and financial incentives can support evidence-based oncology care while improving operational efficiency.
• Integrated care models and alternative payment arrangements may reduce administrative barriers, support patient access, and align financial incentives with quality outcomes.
• Shared savings opportunities, including episode-based payments and home infusion, could help improve resource utilization while maintaining individualized treatment decisions.

Aligning clinical pathways with contracting strategies and financial incentives may help oncology organizations improve patient access, reduce administrative burdens, and support sustainable care delivery, according to panelists at CPC 2026.

During the session, The Economics of Care: Contracting, Incentives, and Shared Savings, Mishellene McKinney, MHA, RN, OCN, vice president of clinical programs at Kaiser Permanente Health Plan and Hospitals, and Deirdre Saulet, PhD, chief strategy and innovation officer at Jasper Health, discussed approaches to integrating clinical quality measures with value-based reimbursement. Gordon Kuntz, president of Kuntz Consulting, moderated the discussion.

Integrating Formularies and Pathways Into Clinical Workflows

McKinney described how Kaiser Permanente's integrated model aligns formulary development, clinical pathways, and physician decision-making.

Physicians, pharmacists, and health plan representatives collaborate on evidence-based formulary decisions, which subsequently inform pathway development.

Rather than functioning primarily as a prior authorization mechanism, the pathways are designed to simplify treatment selection. McKinney explained that clinicians can navigate the pathway and access treatment orders in approximately 5 clicks.

Pathway utilization is approximately 79% to 80%, with performance data reviewed across oncology departments.

McKinney emphasized that pathway concordance should not be treated as an absolute measure of quality because off-pathway decisions may reflect appropriate individualized care.

Using Quality Measures to Support Contracting

Saulet discussed her experience developing oncology centers of excellence networks for self-insured employers.

These arrangements incorporated quality assessments involving pathway adherence, patient experience, symptom management, and adverse event management.

Participating providers meeting quality expectations could receive performance incentives, while employers could waive prior authorization requirements for covered care.

Saulet emphasized that pathway adherence provides a measurable indicator of evidence-based care, although it does not independently establish clinical quality.

Exploring Episode-Based Payments and Shared Savings

Saulet also described episode-based payment models developed for patients with nonmetastatic breast cancer.

These arrangements accounted for differences in disease characteristics and treatment requirements while establishing negotiated episode prices.

Providers could retain savings when care was delivered below the agreed price, provided they met quality requirements.

Patients participating in these programs could receive waived out-of-pocket costs and assistance with travel and lodging.

The discussion also addressed potential shared savings opportunities involving home infusion.

Saulet described emerging arrangements that would allow selected patients receiving established, well-tolerated treatments to receive infusions at home when clinically appropriate.

Such approaches could potentially reduce travel burdens, improve infusion center capacity, and create financial benefits for participating stakeholders.

Implications for Oncology Clinical Pathways

The panelists emphasized that successful value-based arrangements require alignment among clinical decision-making, reimbursement structures, and patient needs.

They also highlighted the importance of maintaining flexibility for appropriate off-pathway treatment decisions and reinvesting resources into patient navigation, supportive services, and clinician participation.

As oncology organizations evaluate alternative payment models, integrating quality measures with patient-centered financial incentives may support more sustainable care delivery without compromising clinical autonomy.

Conclusion

At CPC 2026, panelists highlighted how integrated formularies, pathway-based quality measures, episode-based payments, and shared savings arrangements can support value-based oncology care.

Their discussion underscored the importance of designing financial incentives that improve operational efficiency while preserving evidence-based, individualized treatment decisions.

Reference

McKinney M, Saulet D, Kuntz G. The economics of care: contracting, incentives, and shared savings. Session presented at: Clinical Pathways Congress; November 10-11, 2026; Boston, MA.