Disrupting the Status Quo: The Impact of Purpose-Built Startups in Enabling Value-based Care
For over a decade, the healthcare industry has been attempting a slow and arduous transition to value based care, a delivery model that emphasizes care quality and outcomes over volume of services. There have been pockets of success along the way, but also lots of resources and good intentions poured into efforts that faltered. I have been fortunate to work for two companies that both made real progress in advancing value-based care, Landmark Health, a risk-based in-home complex care provider, and Kidneylink, the value-based care division of U.S. Renal Care which partners with nephrologists to manage late-stage CKD and ESRD in risk-based arrangements. I’ve seen the transformational impact of a value-based model on patients and the providers who care for them – not only in improving outcomes but also in engaging and empowering all stakeholders to solve important barriers to better health. I recently joined Thyme Care because I see that same energy, experienced insight, technology, and passion being brought to cancer care.
In my view, when it comes to value-based models, cancer care today is where chronic kidney care was five or more years ago. And, just as success with chronic kidney patients relies on a kidney-focused care model that is integrated with the nephrologist, cancer care can be greatly enhanced by deploying oncology-focused clinical navigation in partnership with oncologists. In introducing myself to the Thyme Care world, I’d like to talk about those parallels and why I think cancer care is ripe for value-based care disruption.
The Benefits of Moving Upstream, Better Coordination and Aligned Incentives
When I first began working in healthcare, I consulted with health plans and health systems on their value-based care strategies. It was early days for value, and we were particularly concerned with how health plans could partner with providers to share more risk, and how providers could shift toward value while still keeping their footing in fee-for-service medicine.
Early on, we saw that it was very difficult to succeed at value-based care without a model that is purpose-built for the specific patient cohort and that aligns incentives between all parties, including the providers. I witnessed this first-hand while working with several organizations to help them design a model for delivering care to chronically ill patients in their homes – something that turned out to be incredibly difficult for a large organization. Creating an in-home complex care model involves completely different clinical team skill sets, workflows, mindsets, and technology systems. Most importantly, it was difficult to create truly aligned incentives within the organization.
I joined Landmark Health because they were creating such a model from the ground up. We were one of the first companies to go to market with an in-home complex care model, and we needed to break new ground in a range of areas to succeed. This included contracting and partnering with payers and providers in new ways and bringing in-home complex care to scale through technology systems we had to build and deploy. One of Landmark’s key success factors was the ability to create aligned incentives for providers delivering patient care.
My time at U.S. Renal Care further validated how critical it is to engage providers and create aligned incentives to improve health while reducing overall spend – exactly what value-based care is supposed to do.
Similar to people with cancer, who rely heavily on their oncologist to manage their cancer treatment and all the ancillary needs that stem from that, people with late-stage CKD rely on their specialist, the nephrologist, to quarterback their healthcare needs. This ranges from managing symptoms and establishing care goals to discussing social health needs and barriers, following up on additional procedures, and much more. Like oncology, most nephrology practices are independent and serve relatively small patient populations. From an administrative and cost perspective, it’s very difficult for them to address the multi-faceted needs of their patients while keeping pace with the number of patients they have to see, especially as the supply of specialists continues to be under pressure. Value-based solutions help make that kind of support possible while reducing the need for avoidable and costly acute care services.
CMS recognizes that reality, too. In 2015, CMMI (Center for Medicare and Medicaid Innovation) launched the Comprehensive End-Stage Renal Disease Care (CEC) model to create ESRD Seamless Care Organizations that effectively operate like ACOs for kidney care. Then in 2022, CMMI expanded the initiative by launching Kidney Care Choices (KCC) that engage patients earlier in their disease progression, and leans on nephrologists to support patients holistically. To succeed in this model, nephrologists turned to companies such as U.S. Renal Care that can provide wraparound clinical resources, focused analytics and experience in managing risk-based contracts to succeed in CKCC.
Once again, the parallels continue. In 2016, CMMI launched the Oncology Care Model (OCM) as a value-based care approach for cancer patients undergoing chemotherapy. CMMI took those learnings as the basis for its newest iteration, the Enhancing Oncology Model (EOM), which requires participating oncologists to provide care navigation, collect patient-reported outcomes, perform social needs screening, and collect data on health equity measures.
None of that is easy to do for independent or small practices with limited numbers of patients; and it’s even harder to bring to scale across the millions of patients around the country. It takes the aligned efforts of many different entities. With nephrology, once CMS launched an effective VBC program for Medicare beneficiaries, private payers soon followed suit. I believe we’re not yet seeing that happen in oncology because cancer is even more complex. Cancer is not monolithic in how it's treated (unlike nephrology) and represents a number of disease states, each with different patterns of spend. Value-based care transformation in cancer requires more than just aligned financial incentives, it requires a deep understanding of where the opportunities for enhancement and cost-savings lie, an emphasis on reduction of acute care utilization, and an appreciation for novel solutions such as patient navigation that payers and practices may find difficult to fund and build in-house.
To that end, at Thyme Care we’re doubling down on capabilities that support our payer and provider partners in enabling value-based care in oncology. We have purpose built a patient-centric cancer navigation solution focused on reducing total cost of care and improving outcomes. Our care management platform, Thyme Box, seamlessly integrates with community oncologists through EHR access, integrated workflows and expedited access to care, and unlocks additional interventions to drive value, all while aligning incentives. We built capabilities to integrate with community oncologists through EHR access, integrated workflows, and priority access, and to unlock additional interventions to drive value, all while aligning incentives. Our partnership structure with payers relies on total cost of care and ensures that we deliver value to our partners. Our goal is to be the oncology partner of choice for any risk-bearing entity. We see that tripartite relationship between payer, provider, and Thyme Care as key to moving value-based cancer care forward.
Making Value-Based Care Work
I believe in value-based care. I’ve seen how powerfully it can impact care outcomes and costs in three different sectors of healthcare. Based on that experience, I have strong views on what it takes to make value-based care work.
At Landmark Health, I saw the importance of a purpose-built solution. Value-based care is so different from fee-for-service medicine that it requires an entirely different model. Reconfiguring or redesigning existing skill sets, workflows, and technology systems is no substitute for building a solution from the ground up with a specific population in mind and aligned incentives that help facilitate quality and reduce costs.
At U.S. Renal Care, I also saw how critical it was to partner with the specialists who sit at the center of care. The purpose-built solution must work through those specialists, not around them, supporting them by streamlining their workflows, coordinating care and any outside services, and helping patients overcome their specific barriers to access and adherence.
And I’ve seen the inherent advantages that startups have in making innovative approaches work. They can start small, learn and optimize before they bring their solutions to scale. And they’re oriented toward collaborating with existing stakeholders because they don’t succeed unless their solutions are worth paying for and adopting. They also typically attract curious, creative people who have an unusual tolerance for uncertainty and enough determination, persistence, and resilience to push through difficult obstacles. And in healthcare, it’s especially important that at least some of the people who lead startups also have deep expertise in the industry itself.
I’m excited to join Thyme Care because it combines all three of these elements which I think will help bring value-based care to cancer care. It’s my hope that we’ll look back five or so years from now and see a meaningful difference in care outcomes, experience, and cost reductions for cancer patients across the country.