The integration of palliative care alongside oncologic treatment is a best practice strongly recommended by the American Society of Clinical Oncology, a stance reinforced by extensive evidence demonstrating its benefits.1 Palliative care not only enhances patients’ quality of life through better symptom management but also supports caregivers, mitigates cancer-related distress, reduces aggressive end-of-life care, and may even prolong survival.2-4 Additionally, it contributes to lower health care costs by decreasing unwanted interventions.5,6 Acknowledging these advantages, CMS took steps to incentivize integration efforts by launching the Enhancing Oncology Model (EOM) in July 2023. Through the EOM, CMS has tied financial performance-based payments and penalties to 6 quality measures, with 2 directly addressing end-of-life care utilization.7 This underscores a significant push within the US health care system to focus on improving end-of-life care as a central mechanism to enhancing quality and bending the cost curve in oncology.
Yet despite both professional and governmental calls to action, 3 critical operational challenges have impeded the widespread implementation of palliative care in oncology: (1) correctly “dosing” palliative care in our clinical workflows—surfacing which patients should receive it and at what point in their disease course, (2) ensuring the efficient allocation of palliative care specialists in the face of workforce constraints, and (3) establishing a sustainable economic model that supports palliative care delivery within oncology practices.
Recognizing these barriers, the American Oncology Network (AON), a national alliance of over 275 oncology providers across 20 states, partnered with a value-based cancer care enablement company to develop a scalable palliative care solution in the context of its participation in EOM. Thyme Care (TC), where several of this article’s authors work, brought the technical expertise, data infrastructure, and programmatic support necessary for AON to tackle these challenges. By staffing a novel, multidisciplinary care team available 24/7 that acted as an extension of AON and equipping providers with population-level insights into their patients, this collaboration aimed to redefine how palliative care was integrated into oncology. This article details our approach to overcoming systemic barriers and highlights the strategies that were employed to enhance the value and experience of care for patients facing advanced cancer.