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Oncologist and health technology veteran Bobby Green, MD, who practiced for 17 years in Florida and was previously at Flatiron, is now president and chief medical officer of Thyme Care. He moved to Nashville, Tennessee, to start Thyme Care.
Navigating cancer care is not a new, unproven idea. The value of matching a patient diagnosed with cancer with someone who knows the system — who can schedule appointments, warn of drug effects, or connect a family with counseling — has been demonstrated for the first time in years. 1990 when Harold P. Freeman, MD, created a program at Harlem Hospital in New York to help poor, mostly minority patients with follow-up care.1
Patients in the program had remarkably improved outcomes compared to similar patients at the same hospital who lacked support. For those who receive the navigation, the 5-year survival rate nearly doubled from 39% to 70%.
In several studies since then, the results have confirmed Freeman’s findings: cancer care navigation 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, as this group of oncologists and health-tech leaders have been busy with other successful startups, including Flatiron Health, they’ve heard from friends who were baffled by the task of guiding a being expensive through cancer treatment. The idea that not everyone knows a friend in the cancer field begged for a solution, and in 2020 the founders started a company to bridge the navigation gap.5
Oncologist and health technology veteran Bobby Green, MD, who practiced for 17 years in West Palm Beach, Fla., and was previously at Flatiron, is now president and chief medical officer of Thyme Care. He moved to Nashville, Tennessee, where Thyme Care is among the city’s health tech startups and has nestled among investment funds that focus on those companies. The Nashville-based funds are among those that helped Thyme Care raise $22 million in October 2021.6
During an interview at the company’s office, Green explained that Thyme Care is not trying to replace the one-on-one relationship a patient develops with a cancer care navigator. “Especially with cancer, there’s a human component, which you just can’t replace with technology,” he said. “And there’s a complexity in things that technology can never fully solve.”
Giving people with cancer an app and expecting them to navigate their cancer journey won’t work. But pairing browsers with technology can make the process more efficient. That’s how Thyme Care hopes to bring care navigation to everyone, at scale, using technology to determine who needs services on what day and deploying staff precisely where they’re needed.
In typical practice, “you might have a browser that 4 days a week is really really busy – and 1 day a week it’s not,” Green explained. Without technology, there is no way to effectively leverage that person’s time. In a virtual model, “if they’re really busy with a practice 5 days a week, they can focus on that practice. But if there are downtimes, they can help patients from another practice. The advantages of a virtual model and a technology-based model are that they allow you to allocate resources more efficiently. »
During the interview, Green said data scientists in the next room were refining Thyme Care’s “acuity scores,” which assess each patient’s risk of something going wrong, like a bad symptom. or a trip to the emergency room (ED). The key is not only to anticipate these bad events, but also to know when making contact will make a difference.
“How do you identify who is most at risk of bad things happening, but also know when your interventions are going to help – because it’s not doing the patient any good, and it’s not an efficient way to use resources so that we were trying to do interventions that won’t work,” Green said.
“So how do you identify people who are likely to go to the emergency room, for example, but also [identify] people [for whom] do you think you have an intervention that will prevent them from going to the emergency room? Because no one is helped if we intervene with someone who is about to go to the emergency room if they have to go to the emergency room.
Technology also makes it possible to personalize contacts with patients. For example, if the patient can handle Zoom and wants to include caregivers in a call, that’s fine. But those using a landline will get a call that way, Green explained.
How it works?
Thyme Care customers are health plans, but their collaborators will be practices. Navigating might involve connecting a newly diagnosed patient with the right oncologist, or it might mean offering emotional support, or it might mean managing the cascade of phone calls that begins with a single canceled appointment.
Green recreated a typical message from a patient: “My PET scan just got cancelled. I have to see the oncologist the day after the PET scan. But since I didn’t have my PET scan, should I reschedule the oncology appointment? And how can I be sure that the oncology appointment is moved until my PET scan is rescheduled, when my PET scan has not yet been rescheduled? And by the way, they told me my PET scan was postponed because of my diabetes – does that mean I have to call my GP?”
“So this stuff happens all the time,” Green said.
In addition to relieving these burdens from the patient or a caregiver, such as an adult daughter who still has her own job, Thyme Care staff take care of tasks such as reporting patient symptoms electronically. More importantly, they ensure that patients mention symptoms to their oncologist. The services are valuable to the practices, Green said, and they’re also valuable to the health plan. “Ultimately, we should also be able to deliver value in value-based care,” he noted.
Who pays for navigation?
Navigation relied on individual practices or institutions with the resources to hire staff, with funding from a variety of sources, including short-term grants. Medicare is not required to fund navigators, although alternative payment models or those that reimburse providers for chronic care management have been used for this purpose.7 Over the past 6 years, many many practices that have participated in the Oncology Model of Care (OCM), navigation services supported with monthly MEOS (Enhanced Oncology Services) payments from CMS. Some oncologists have expressed concern that smaller practices will struggle to maintain navigation services when MEOS payments cease after June 30, 2022.
The future may bring more sustainability to cancer navigation if payers provide the revenue, based on the savings that navigation demonstrates. A 2017 study in Health Affairs found that Oncology Medical Home and other patient navigation models were associated with lower costs in the last 90 days of life, compared to usual care: $3,346 vs. $824, respectively, as well as fewer hospitalizations in the past 30 days. .2 Patient navigation, in particular, was linked to fewer emergency department visits and increased palliative care enrollment. A 2019 report called on the Center for Medicare and Medicaid Innovation to provide sustainable navigation funding in future models, to ensure health equity.seven
“It’s about trying to think about how to use technology to help people at scale,” Green said.
In September 2021, Thyme Care formed a partnership with Clover Health to provide services to underserved members of Clover Medicare Advantage in New Jersey.8 “Revenue comes from health plans. We do not charge patients; we don’t charge vendors,” Green said. Nevertheless, the Thyme Care model calls for full collaboration and alignment of incentives. He has seen these relationships from both the business side and the practice of oncology, and he knows that vendor engagement can suffer when a third party provides the navigation. “Supplier orientation is really important,” Green pointed out.
Does the end of the OCM create a need for Thyme Care? Yes, health plans are interested, even though there is a lot of CMO information they are willing to leave behind.
We’ve taken the position that we want to help build models that are very clinician/oncologist-centric, and bring the tools, technology, and expertise to determine what are the right value-based models of care to align the incentives between health plan and practice, then bring the technology to enable them,” Green said.
“People are very motivated to try to improve the patient experience, to foster higher value care, to prevent acute care events, to ensure that the therapies people receive are the therapies of the highest value,” Green said. “And I think that’s a space where health plans and oncologists are very aligned.”
References
1. Freeman HP. Patient Navigation: 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 utilization and expense. Health Aff (Millwood). 2017;36(3):433-440. doi:10.1377/hlthaff.2016.1303
3. Dillon EC, Kim P, Li M, et al. Navigating Breast Cancer: Using Physician and Patient Surveys to Explore the Experiences of Nurse Navigator Programs. Clin J Oncol Nurs. 2021;25(5):579-586. doi:10.1188/21.CJON.579-586
4. Dixit N, Rugo H, Burke NJ. Navigating equity in cancer care: the role of patient navigation. Am Soc Clin Oncol Educ Book. 2021;41:1-8. doi:10.1200/EDBK_100026
5. Care of thyme. Home page. Accessed May 14, 2022. https://www.thymecare.com/
6. Andreessen Horowitz is leading $22 million in funding for Thyme Care to improve patient outcomes, close gaps in health disparities, and drive value-based cancer care. Press release. Business Wire; October 5, 2021. Accessed May 14, 2022. https://bwnews.pr/37JQXjE
7. Osundina F, Garfield K, Downder S. National Roundtable on Navigation: Patient Navigation in Cancer Care: Examining Payment Models for a Sustainable Future. Center for Innovation in Health Law and Policy. 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 help members navigate their cancer journey. Press release. Business Wire; September 1, 2021. Accessed May 14, 2022. https://bwnews.pr/3l8UXgG
