Bobby Green, MD, an oncologist with experience in health technology who formerly worked for Flatiron and had a 17-year Florida practice, is now president and chief medical officer of Thyme Care. In order to start Thyme Care, he moved to Nashville, Tennessee.
Navigation of cancer care is not a novel or untested concept. When Harold P. Freeman, MD, established a program at Harlem Hospital in New York to assist underprivileged, primarily minority patients with follow-up care in the 1990s, the importance of pairing a patient with cancer with someone who knows the system—who can schedule appointments, warn about side effects from medications, or connect a family with counseling—was first made clear. 1
Patients in the program had remarkably improved outcomes compared with similar patients at the same hospital who lacked assistance. For those receiving navigation, the 5-year survival rate nearly doubled, from 39% to 70%.
In multiple studies completed since that time, 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.
Thyme Care's creators were aware of this. They heard from friends who were perplexed by the challenge of leading a loved one through cancer treatment throughout the last decade when this group of doctors and health technology specialists was occupied with other successful firms, most notably Flatiron Health. Because not everyone has a buddy who works in the cancer area, a firm was founded in 2020 by the founders to fill the navigational gap. 5
Bobby Green, MD, an oncologist with experience in health technology who formerly worked for Flatiron and had a 17-year practice in West Palm Beach, Florida, is currently president and chief medical officer of Thyme Care. Thyme Care is one of the city's health tech firms and is tucked among the investment funds that concentrate on these enterprises. He has migrated to Nashville, Tennessee. Thyme Care collected $22 million in October 2021 with assistance from a number of Nashville-based funds. 6
Green clarified that Thyme Care doesn't aim to replace the personal connection patient forms with a cancer care navigator during an interview at the company's headquarters. "There's a human touch component, especially with cancer, that you really can't substitute with technology," he added. Additionally, there are complicated issues that technology will never be able to fully resolve.
It won't work to give cancer patients an app and then expect them to manage their disease experience. However, the procedure may be made more effective by combining navigators and technology. By utilizing technology to determine who needs services on which days and by dispatching staff precisely where they are needed, Thyme Care wants to provide care navigation to everyone on a large scale.
According to Green, in normal practice, "you could have a navigator who is extremely, really busy 4 days a week—and they're not 1 day a week." It is impossible to adequately utilize a person's time without technology. If they have a practice five days a week and are really busy, they can concentrate on that practice in a virtual model. However, if there is a lull, they can assist patients at another office. Both a virtual model and a model supported by technology have the benefit of making resource allocation more effective.
Green stated during the interview that data scientists were adjusting Thyme Care's "acuity scores," which determine each patient's likelihood of experiencing a negative event (such as a nasty symptom or a visit to the emergency room) (ED). Predicting these unfortunate circumstances is important, but it's also important to know when establishing contact can be beneficial.
Green asked, "How do you identify the people who are most at risk of bad things happening, but then also be conscious of when your interventions are going to be able to help—because it does the patient no good, and it's not an efficient use of resources for us to be trying to make interventions that are going to work,"
The question is, "How can you identify folks who, for instance, are likely to visit the ED, but also [identify] persons [for whom] you feel you have a preventative intervention? Because meddling with someone who is about to visit the emergency room when they should be there does not benefit anyone.
Customized patient interactions are also possible thanks to technology. For instance, it's OK if the patient can use Zoom and wants to phone in the carers. However, according to Green, landline users will receive a call in this manner.
How Does It Work?
Health plans are Thyme Care's clients, but practices will work with them as partners. Offering emotional support, finding the appropriate doctor for a newly diagnosed patient, and managing the phone calls that follow a single canceled visit are all examples of navigation.
"My PET scan just was canceled," Green reenacted a common patient message. The day following the PET scan is when I'm due to visit the oncologist. Do I need to reschedule the oncology visit given that I didn't have my PET scan, though? And given that my PET scan hasn't been rescheduled yet, how can I ensure that it isn't moved until after my next meeting with the oncologist? Do I need to call my primary care physician if, as they mentioned, my PET scan has to be rescheduled due to my diabetes?
So, Green said, "That sort of stuff happens all the time."
The Thyme Care team handles activities like electronically reporting patient symptoms in addition to relieving the patient or caregiver of these responsibilities, such as a grown daughter who still works for herself. Most essential, they make sure that patients tell their oncologist about any complaints. According to Green, the services are beneficial to both the practices and the health plan. Finally, he said, "We ought to be able to deliver value in value-based care as well."
Who Pays for Navigation?
With money coming from a variety of sources, including short-term grants, navigation has relied on particular practices or institutions having the capacity to recruit personnel. Although alternative payment models or those that compensate physicians for chronic care management have been employed for this purpose, Medicare is not required to pay navigators. 7 Many clinics that participated in the Oncology Care Model (OCM) during the course of the last six years sponsored navigation services with monthly Enhanced Oncology Services (MEOS) reimbursements from CMS. When MEOS funding stop after June 30, 2022, several oncologists worry that smaller practices won't be able to continue providing navigator services.
Based on the savings that navigation shows, the future may offer more sustainability for cancer navigation provided payers give the funding. The Oncology Medical Home and other patient navigation models were linked to reduced expenses in the final 90 days of life compared to conventional care ($3346 vs. $5824, respectively), as well as fewer hospitalizations in the final 30 days, according to a 2017 research published in Health Affairs. 2 Particularly, patient guidance was connected to a decrease in ED visits and an increase in hospice participation. In order to ensure health equity, a 2019 report urged the Center for Medicare and Medicaid Innovation to include sustainable navigation financing in upcoming models. 7
Green explained that the goal is to consider how technology may be used to benefit a large number of people.
To provide services to neglected Clover Medicare Advantage members in New Jersey, Thyme Care and Clover Health partnered in September 2021. 8 "Health plans provide the funding. Green stated, "Neither do we charge the patients nor the providers. However, the Thyme Care concept requires complete collaboration—as well as incentives that are in line. He is aware that when a third party offers direction, provider engagement might decrease. He has observed these interactions from both the business side and in cancer practice. Green emphasized the need for provider attention.
Does Thyme Care become necessary with the OCM's end? Yes, health plans are intrigued, despite the fact that there are many aspects of the OCM that they are willing to forget.
We've adopted the stance that we want to assist in the development of models that are primarily focused on clinicians and oncologists, and we'll bring the tools, technology, and expertise to determine which value-based care models will best align the incentives between the health plan and the practice—and then we'll bring the technology to support them, according to Green.
According to Green, "people are very driven to try and enhance the patient experience, to promote higher-value care, to reduce acute care events, and to ensure that the therapies patients are getting are the highest-value therapies. And I believe that area is one in which oncologists and health plans are closely allied.
References
1. Freeman HP. Patient navigation: a community-based 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 spending. Health Aff (Millwood). 2017;36(3):433-440. doi:10.1377/hlthaff.2016.1303
3. Dillon EC, Kim P, Li M, et al. Breast cancer navigation: using physician and patient surveys to explore nurse navigator program experiences. Clin J Oncol Nurs. 2021;25(5):579-586. doi:10.1188/21.CJON.579-586
4. Dixit N, Rugo H, Burke NJ. Navigating a path to 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. Thyme Care. Home page. Accessed May 14, 2022. https://www.thymecare.com/
6. Andreessen Horowitz leads $22M in funding for Thyme Care to improve patient outcomes, close gaps in health disparities, and drive value-based cancer care. News release. BusinessWire; October 5, 2021. Accessed May 14, 2022. https://bwnews.pr/37JQXjE
7. Osundina F, Garfield K, Downder S. National Navigation Roundtable: patient navigation in cancer care: a review of payment models for a sustainable future. Center for Health Law and Policy Innovation. 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 strategic partnership with Clover Health to support members navigating through their cancer journey. News release. BusinessWire; September 1, 2021. Accessed May 14, 2022. https://bwnews.pr/3l8UXgG
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