The P4 Pathways Program seamlessly adapts to provide compliance monitoring and reporting that fits the needs of our partners while being unobtrusive to providers and point-of-care. Our methods are best-in-class, highly innovative, and easy to implement. P4 Pathways manages all facets of the program. Beyond the payer providing the necessary claims data to allow us to perform the compliance and return on investment (ROI) analyses, there are minimal additional duties required from the payer or the providers.

On-going compliance monitoring and reporting are critical to the P4 Pathways Program for modifying behavior, determining participation, and evaluating success. The compliance database for participating physicians utilizes several resources. The primary source is the eobONE reimbursement management and data analysis service, which electronically collects ANSI 837 claims and 835 remittance files. eobONE also provides data for compliance analysis, which allows our partners to quickly understand real-time oncology spending and behavior. A simple one-page faxed form may be necessary in some instances for patients on clinical trials, in hospice care, receiving approved oral agents, etc. Our partners can contribute data to the warehouse, which is aggregated with the P4 Pathways data to provide a more complete analysis.

The P4 Pathways analysis team will typically monitor compliance and generate reports on a quarterly basis for all participating practices based on the current, approved treatment and/or supportive care pathways. Additional monitoring can also be built into the process depending on our partners’ needs. Reporting typically includes compliance, overall participation, and ROI of the program. The levels of analysis can include practices within the Pathways Program, providers within the practices, and patients within providers.

Ongoing compliance monitoring allows for behavior modification opportunities. Data is run through the compliance algorithm to produce quarterly compliance reports. Non-compliant regimen analysis is conducted for special circumstance allowances and validation. Sample chart audits are also conducted for validation. Compliance is sent to providers and posted on the web portal, where providers can review scores and appeal relevant adverse determinations. Appeals are reviewed and final compliance adjudication and scoring are made available. A quarterly physician compliance webinar is conducted, and Pathways are updated accordingly. Non-compliant practice correction plans and meetings are also implemented.

Compliance Determination