In U.S. healthcare today, traditional health plans are massive organizations that are a mile wide and an inch deep. This makes them very well-suited for some purposes and not quite as effective for others. For example, health plans are extremely efficient at facilitating access and payment for a large number of members and providers at scale. But they’re not as good at developing home-grown solutions that reinvent processes, meet deeper market or technology needs, or serve specific member segments.
For that kind of innovation, they are increasingly turning to healthcare startups – nimble, fast-paced companies that are hard-wired to develop solutions to meet very specific healthcare needs, and are relentless about finding their way past barriers.
It's not easy, however, for health plans and startups to get what they need from each other when they embark on a close working relationship. Each side has different priorities around product development, decision-making, speed, readiness, and so on, that must be skillfully managed or navigated to facilitate adoption and success. I know this from first-hand experience as the former head of the corporate venture capital group at Horizon Blue Cross Blue Shield of New Jersey.
Recently, I crossed over to the startup side of the aisle by joining Thyme Care - an exciting and rapidly growing leader in value-based cancer care navigation - as Senior Growth Partner, and AlleyCorp, an early stage venture fund and incubator. Reflecting on that decision, I want to explain how I’ve seen the startup/health plan collaboration work best; and why I think that startup-driven innovation, particularly in the cancer care delivery space where Thyme Care is doing transformational work, is so critical for moving the needle on healthcare’s biggest challenges around costs, quality, access, and member experience.
Even though I worked at one of the biggest health plans in the country for 14 years, I’ve always had an entrepreneurial mindset. That’s why I jumped at the opportunity to launch Horizon’s corporate venture capital effort 7 years ago. I loved identifying promising solutions in the market and helping Horizon’s members and providers benefit from them.
It takes a leap of faith for a health plan and a startup to join forces. Almost by definition, an earlier-stage venture’s solution is either not ready to implement in a pure “plug-and-play” way, or has yet to see widespread market adoption. The startup needs access to the health plan’s member/provider base to test and develop its solution under real-world conditions.
In turn, the health plan is motivated by the opportunity it sees in a new solution (that’s not necessarily broadly available elsewhere) to serve its own strategic needs and be brought to scale. Even with all the due diligence that gets performed, however, that’s still a risky decision. Beyond the financial outlay, the health plan must feel confident advocating for that solution internally and to its member/provider base and large customers. Will the startup be able to ultimately do what it promises?
There are a few factors that can increase the likelihood of success for these partnerships. The solution itself is critical, of course, but so is the relationship. It will take collaboration, commitment, and persistence to succeed. That’s why the quality and experience of the startup’s leadership team is incredibly important.
The team needs to have the gravitas and industry experience to be taken seriously; the confidence to do big things; the humility to listen, learn, and be accountable; the ability to deliver on its promises; and the flexibility to pivot or adjust when necessary. Have they built a solution before at a previous company? Do they understand the technology and the market better than anyone else? That’s the basis for developing deep trust and accountability, and engaging in clear communication.
To be a good partner, the health plan must provide the startup with quick answers to its questions and support working through internal bureaucratic processes. The startup needs a strong “main contact” or sponsor inside the plan with a good internal network, decision-making authority and passion for the solution.
Ultimately the payoff is worth it. It can be hard for a startup to “crack the code” of a health plan, but once they’re in, they can begin to gain a lot of traction and credibility quickly. At Horizon, that included access to some portion of our 3.6 million member base, a lot of support, and deep insights into how healthcare actually works. In turn, that helps the startup gain momentum with other health plans too, as well as key stakeholders like hospital systems, insurance brokers and even large employers.
At Horizon, I made my investment decisions based on high-value areas of need and how much confidence I had in the solution and the management team. I looked for startups that could help us fill gaps where we weren’t strong, and where we could complement the startup’s expertise with our own.
Today, one of the biggest areas of need for healthcare is better cancer care delivery.
Cancer is a huge cost to our healthcare system, and one of the most difficult and challenging experiences for a patient. Although recent diagnostic and therapeutic advances have been staggering, innovation in cancer care delivery still lags.
Most health plans are not well-equipped to manage care for cancer patients in a way that measurably improves quality and cost. Part of that problem is nuance. As I said earlier, health plans are a mile wide and an inch deep, but each cancer care journey is unique and changes over time. There are many different forms of cancer, and members have an array of needs depending on their own specific circumstances. Access and coordination are major challenges. Members also often need social services to help them navigate, access and adhere to care, but such services live outside the traditional scope of care.
Recognition of that reality is starting to drive more investment in condition-specific startups and new approaches. In that sense, cancer care delivery may be where diabetes care delivery was a decade ago.
I think Thyme Care is a leader in the oncology space because of its innovative advances in cancer care navigation, its commitment to value-based care, and the quality of its team. The company may be a startup, but it has progressed well past the vision stage and has already gained significant traction and meaningful results with payers in the market.
Thyme Care’s approach to cancer care navigation combines robust data and technology with dedicated human support in the form of care guides that assist patients through their cancer journey. Patients and providers need that human connection and commitment to overcome barriers to access and improve quality outcomes. Thyme Care’s data and technology supports that human touch by proactively identifying members in need of more supportive services, and coordinating access to oncology care and social services.
Thyme Care is also at the forefront of what value-based care models can do in terms of providing the right incentives and support for more coordinated and cost-effective clinical and social care. A recent analysis, presented at the 2022 ASCO Quality Care Symposium, shows that Thyme Care interventions have reduced total cost-of-care by $429 per member per month, proving that cancer care navigation assistance significantly moves the needle on costs.
Given the prevalence of cancer, the inflation of medical costs, the complexity of care delivery and the emotional, physical and financial toll of a poor care experience, it’s surprising the industry hasn’t already honed in on solutions that offer value-based cancer care delivery at scale. Thyme Care has built a model with health plan partners that delivers value for all stakeholders involved.
Finally, the team at Thyme Care is another advantage. With my investor hat on, I see a team that combines deep, top-line experience across all key areas of cancer care delivery; and a company that has already proven its ability to execute and drive significant organic growth. It is motivating to see Thyme Care’s collective passion and vision for creating a new cancer care delivery model that addresses a critical need for health plans, cancer patients and cancer care providers alike.
After years with a health plan, I’m incredibly excited to work on the start-up side of that collaboration, with high-energy people, where problems get tackled quickly and creatively, the pace is fast, and we get rewarded with growth and the satisfaction of improving cancer care for millions.
Thyme Care has made a lot of progress in the past couple of years. But there’s a lot of work still in front of us. I’m looking forward to contributing by using my experience, knowledge and expertise to help Thyme Care succeed with health plans, investors and members around the country.