A Human Touch in Cancer Care, Guided by Technology

Veteran health and oncologist Bobby Green, MD, who practiced 17 years in Florida and was previously with Flatiron, is now Thyme Care’s president and chief medical officer. He has moved to Nashville, Tennessee, to launch Thyme Care.

Navigating cancer care is not a new, unproven idea. The value of pairing a patient with cancer with someone who knows the system — who can make appointments, warn about the effects of medications, or connect the family to counseling — was first demonstrated in the 1990s when Harold P. Freeman, MD, established a program at Harlem Hospital in New York to help poor patients, most of whom are from Minorities, in follow-up care.1

Patients in the program achieved significantly improved outcomes compared to comparable patients in the same hospital who lacked assistance. For those receiving navigation, the 5-year survival rate nearly doubled, from 39% to 70%.

In several studies completed since that time, results confirmed Freeman’s findings: Navigation in cancer care can improve patient experience and outcomes, and even reduce costs.2-4 Unfortunately, despite the evidence, navigation is not universal.

The founders of Thyme Care knew this. Over the past decade, this group of oncologists and health tech leaders has been preoccupied with other successful startups — notably Flatiron Health — hearing from friends baffled by the task of guiding their loved ones through cancer treatment. The notion that not everyone knows a cancer friend is begging for a solution, and in 2020, the founders launched a company to bridge the mobility gap.5

Veteran health and oncologist Bobby Green, MD, who practiced 17 years in West Palm Beach, Florida and was previously with Flatiron, is now Thyme Care’s president and chief medical officer. He’s moved to Nashville, Tennessee, where Thyme Care is among the city’s health-tech startups — and it’s among the investment funds focused on these ventures. The Nashville-based funds are among those that helped Thyme Care raise $22 million in October 2021.6

During an interview in the company’s office, Green explained that Thyme Care does not attempt to replace the individual relationship a patient develops with a cancer care navigator. “Especially with cancer, there’s the element of human touch, which you can’t replace with technology,” he said. “And there is a complexity in the things that technology will not be able to solve completely.”

Giving people with cancer an app won’t work and expecting them to navigate the cancer experience. But pairing navigators with technology can make the process more efficient. This is how Thyme Care hopes to provide mobility in care for everyone, at scale — by using technology to find out who needs services on which day, and by deploying employees precisely where they need them.

In a typical practice, “You might have a navigator who is really busy 4 days a week — and 1 day a week, which isn’t,” Green explained. Without technology, there is no way to make effective use of this person’s time. In a hypothetical model, “If they are really busy doing 5 days a week, they can focus on that practice. But if there is downtime, they can help patients with another practice. The advantages of both the virtual model and the tech-enabled model are that it allows you to allocating resources in a more efficient manner.

During the interview, Green said the data scientists in the next room were adjusting Thyme Care’s “acuteness scores,” which assess each patient’s risk of something going wrong — like bad symptoms or a trip to the emergency department (ED). The key is not only to anticipate these bad events, but also when communication will make a difference.

“How do you identify the people who are most at risk of bad things happening, but then also be aware of when your interventions will be able to help — because they don’t benefit the patient with anything, and it’s also not efficient to use resources for us to try to do interventions that won’t work,” Green said.

“So, how do you determine who is likely to go to the emergency department for example, but also [identify] People [for whom] Think you have an intervention that prevents them from going to the emergency department? Because no one is helped if we interfere with someone who is about to go to the emergency department if they have to go to the emergency department.”

The technology also enables the personalization of patient contacts. For example, if a patient is able to manage Zoom and wants to include caregivers on a call, that’s fine. Greene explained that those who use a landline will receive a call this way.

How it works?
Thyme Care clients are health plans, but their collaborators will be practices. Nav can include connecting a newly diagnosed patient with the appropriate oncologist, or it may mean providing emotional support, or it may mean managing the series of phone calls that begin with a single canceled appointment.

Green recreated a sample patient message: “My PET scan has been cancelled. I am supposed to see my oncologist the day after my PET scan. But since I didn’t have my PET scan, do I need to change my oncology appointment? How do I make sure? From moving my oncology appointment until after my PET scan was rescheduled, when my PET scan hasn’t been rescheduled yet?By the way, they told me my PET scan was rescheduled because of my diabetes – so does that mean I need to call my primary care physician?”

“So, this kind of thing happens all the time,” Green said.

In addition to removing such burdens from the patient or caregiver—such as an adult daughter still working on her own—the Thyme Care team handles tasks such as reporting a patient’s symptoms through electronic means. Most importantly, she makes sure that patients report symptoms to their oncologist. Green said the services are of value to the practices, as well as of the health plan. “Ultimately we should be able to deliver value in value-based care as well,” he noted.

Who pays for navigation?
Navigation relied on individual practices or institutions that had the resources to hire staff, with funding coming from a variety of sources, including short-term grants. There is no requirement for Medicare to fund navigators, although alternative payment models or those that reimburse providers for chronic care management are used for this purpose.7 Over the past six years, several practices have engaged in Oncology Care Model (OCM), navigating services Backed with monthly Enhanced Oncology Services (MEOS) payments from CMS. Some oncologists have expressed concern that smaller practices will have trouble maintaining navigator services when MEOS payments stop after June 30, 2022.

The future may bring more sustainability to cancerous navigation if payers provide revenue, based on the savings that navigation demonstrates. A 2017 study in Health Affairs found that home oncology and other patient mobility models were associated with lower costs in the last 90 days of life, compared to usual care: $3,346 versus $5,824, respectively, along with fewer hospitalizations in the last 30 days. 2. Patient mobility, in particular, has been linked to fewer emergency department visits and increased enrollment in hospice homes. A 2019 report called for the Center for Healthcare and Medicare Innovation to provide sustainable navigation funding in future models, as a way to ensure health equity.7

“It’s about trying to think about how technology can be used to help people at scale,” Green said.

In September 2021, Thyme Care formed a partnership with Clover Health to provide services to Clover Medicare Advantage members in New Jersey.8 “Revenue comes from health plans. We don’t charge patients. We don’t charge providers,” Green said. However, the Thyme Care model calls for full collaboration and incentive alignment. He has looked at these relationships from the business side and in the A practicing oncologist, he knows provider involvement can suffer when a third party provides mobility.’Focusing on the provider is really important,’ Green stressed.

Does the end of OCM create a need for thyme care? Yes, health plans are concerned, although there is a lot about OCM that they are willing to leave behind.

We’ve taken the position that we want to help build clinician/oncologist-centric models, bring tools, technology and expertise to figure out the right value-based models of care to align incentives between health planning and practice — and then bring technology to empower them,” Green said.

“People are very excited about trying to improve the patient experience, to drive higher value care, prevent acute care events, and make sure that the treatments that people get are the most valuable treatments,” Green said. “And I think that’s where health plans and oncologists pretty much align.”


references

1. Freeman HP. Patient mobility: a community strategy to reduce cancer disparities. J Urban Health. 2006; 83(2): 139-141. doi: 10.1007/s11524-006-9030-0
2. Murphy Colligan E, Ewald E, Ruiz S, Spafford M, Cross-Barnet C, Parashuram S. Innovative oncology care models improve end-of-life quality, reduce use and expenditure. Health F (Melwood). 2017; 36 (3): 433–440. doi: 10.1377/hlthaff.2016.1303
3. Dillon EC, Kim B, Lee M, et al. Navigating Breast Cancer: Using Physician and Patient Surveys to Explore Experiences of the Nurse Navigator Program. Clin J Oncol Gull. 2021; 25 (5): 579-586. doi: 10.1188/21.CJON.579-586
4. Dixit N, Rojo H, Burke NJ. Navigating equity in cancer care: the role of patient mobility. Am Soc Clin Oncol Educ Book. 2021; 41: 1-8. doi: 10.1200/EDBK_100026
5. Thyme care. Homepage. Accessed May 14, 2022. https://www.thymecare.com/
6. Andreessen Horowitz leads $22 million in Thyme Care funding to improve patient outcomes, close gaps in health disparities and advance value-based cancer care. New release. Business Wire October 5, 2021. Accessed May 14, 2022. https://bwnews.pr/37JQXjE
7. Osundina F, Garfield K, Downder S. National Navigation Roundtable: Patient Mobility in Cancer Care: A Review of Payment Models for a Sustainable Future. Center for Health Law and Policy Innovation. 2019. Accessed May 14, 2022. https://chlpi.org/wp-content/uploads/2013/12/Patient-Navigation-in-Cancer-Care-Review-of-Payment-Models_FINAL.pdf
8. Thyme Care announces a strategic partnership with Clover Health to support members in navigating their journey with cancer. New release. Business Wire September 1, 2021. Accessed May 14, 2022. https://bwnews.pr/3l8UXgG

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