Investing in Thyme Care

“You beat cancer by how you live, why you live, and the manner in which you live. So live, live, fight like hell, and when you get too tired to fight, then lay down, rest, and let somebody else fight for you.” 

— Stuart Scott, American sportscaster and ESPN anchor; passed due to appendiceal cancer

 

“Thyme Care did not give up on me, when I had given up on myself.”

— Cancer patient, and Thyme Care member

 

Patients living with cancer are among my personal heroes. They endure difficult treatment regimens for months and years; they trial some of our most unproven novel therapies with hope and optimism. They find themselves in a clinic or hospital so many times that the medical complex can start to feel like a place of residence; they face, along with their caregivers, a scary and uncertain future with strength and grace.

Thyme Care is about making our healthcare system work better, and more sustainably, for these patients.

The cancer patient experience can be 10X better

I feel lucky to care for cancer patients in my clinical practice as a cancer survivorship physician. And while patient care is immensely rewarding, I also know that the patient experience could — and should — be 10X better. I have seen patients struggle in ways that our healthcare system simply should not tolerate. A young woman undergoing surgery for her brain tumor, with no caregiver on the other side. An elderly Spanish-speaking gentleman whose wife has to fight the system at every step of the way to ensure that her husband can start targeted therapy for lung cancer. A middle-aged man receiving immunotherapy while newly homeless, but lacking access to basic food and transportation. A busy mother of four children without primary care, who finally learns after multiple hospitalizations at different facilities that the nausea she has been quietly battling at home is caused by metastatic gastric cancer.

Cancer care is also not equal for everyone. Care varies substantially by region, by provider, by plan, and by patients’ socioeconomic status. The Thyme Care team (and I) know this not only because we’ve witnessed it directly as providers and family members, but also because many of us had the opportunity to use data to study these phenomena while working at Flatiron Health. The data showed over and over that cancer care varies in cost, quality, and depth. Only some patients are able to access tumor genomic sequencing; only some patients are offered palliative care rather than chemotherapy near the end of their lives; the list goes on.

It is an unacceptable reality of cancer care in this country that far too many patients cite access to care, difficulty navigating the system, and financial toxicity as some of their greatest sources of concern. Indeed, cancer patients are 2.5x more likely to declare bankruptcy than the average American. We must do better.

How are we spending so much on cancer care then? Incentives strike again

So how is it, then, that we spend over $180B annually on cancer care in the U.S.? This pool of resources seems massive — but in reality, a great deal of this spend is fundamentally inefficient, and attributable to misaligned organizational incentives, data, and communication across the three principal participants in the cancer care system: patients (and their caregivers), providers, and payors.

Perhaps the most glaring is fee-for-service reimbursement for oncology care, which reimburses providers and hospitals for individual pieces of expensive care (procedures, visits, therapies), without consideration for long-term quality, or total cost borne by the healthcare system and patient. And even though both the Centers for Medicare & Medicaid Services (CMS) and commercial payors have launched multiple regional and national value-based oncology care models over the past few years, the early data from these programs shows that a) most oncology practices aren’t provided the right resources to succeed in these models, and b) most payors and providers do not have access to the data, technology, or resources required to actually change how and where cancer patients receive care.

How does this play out in practice? Let’s take, for example, a common scenario: a cancer patient on therapy experiences increasing nausea and vomiting, making it difficult for her to eat on a Saturday. In the status quo, she is likely to present to an emergency department and be admitted to the hospital, even though the actual interventions undertaken in the hospital (e.g., prescription of an anti-nausea medication) might have been readily handled in the outpatient setting, at dramatically lower cost, higher patient convenience, and often a more favorable outcome. Why? Because nobody is truly incentivized to prevent this. The outpatient oncology care team has not been incentivized to build after-hours care capacity. The emergency department does not have access to enough data about the patient’s cancer care, so admits her out of precaution. And even when she is discharged from the hospital, care coordination relies on provider trust and goodwill rather than organizational structure. The key problem at the center of this story is that nobody in the value chain is incentivized — on a continuous, longitudinal basis — to pursue proactive symptom management and site-of-service shifts that ultimately serve the patient and system best. And so we get sub-optimal outcomes even when every single physician, nurse, and care manager…is doing the best they humanly can.

The time for Thyme Care…is now (pun fully intended)

There are several important tailwinds that make this a favorable moment to begin executing on a business model like Thyme’s:

• The cost of cancer care is rising rapidly, and expected to approach $250B by the end of the decade as our population ages.
• Oncology payment reform is top-of-mind for both CMS and commercial payors. Multiple new care models (e.g., the CMS Oncology Care First model) are actively being designed, and there is an unprecedented willingness on behalf of payors to recognize both high-value providers, as well as new care management and navigation services.
• Payors like CMS are also looking ahead to more innovative shifts in oncology care (e.g., home-based care), and moving away from previously restrictive constructs such as inpatient-only lists for reimbursement.
• Reciprocally, oncology providers (and health systems) are increasingly willing to align themselves with new care models, but need additional technology and resources in order to succeed.
• Digital health has matured as an industry; the know-how, tools, and talent now exists to design, implement, and rigorously measure the impact of value-based oncology interventions.

The data, technology, and care management required to fundamentally rewire cancer care are now within our reach. We can make our collective dollar go much farther — but we need the data to help guide patients to high-value care from the day they first receive a cancer diagnosis, through the maze of multiple providers they will inevitably encounter along the way (including their trusted primary care provider), and ultimately to the outcomes that patients and families want for themselves. This navigation is exactly what Thyme Care offers its members — and this is also what has been fundamentally missing in prior instances of value-based oncology care.

We could not imagine a group better suited to build this company than Thyme Care’s founding team. We have known them individually for many years, via work at Flatiron Health, and have seen up-close their deep commitment to getting to the right answer on behalf of patients. CEO and co-founder Robin Shah has lived and worked in oncology for over 15 years, initially managing various aspects of his father’s busy community oncology practice, then growing Flatiron Health’s large network of data-aligned community oncology clinics, and most recently launching and running a new value-based community oncology network called One Oncology. In each of these settings, he felt a hunger to more dramatically and directly transform the patient experience, which led him to start Thyme Care. His team now includes one of my favorite former colleagues at Flatiron Health: Bobby Green, a kind, brilliant, and magnetic medical oncologist himself and formerly Flatiron’s Chief Medical Officer. When we heard that Robin and Bobby were teaming up, and bringing together a formidable group of data scientists, engineers, commercial leaders, and care delivery specialists in service of this mission — the opportunity ahead was clear.

It is truly special to partner with a team solving an urgent problem that I care about deeply as a clinician. We are honored to be leading Thyme Care’s latest financing and joining the board. While the individual cancer patients who we serve will always remain our north star, I cannot wait to see Thyme’s impact at scale.