Disclaimer: Flare Capital Companions is an investor in Aetion, Cohere Well being, HealthVerity, Inbound Well being, Iora Well being and VivorCare. See the broader Flare presentation here.
In part one of this article, we highlighted the assorted parts of end-to-end most cancers care supply and administration and the way innovators have emerged to deal with right this moment’s unmet wants. We unbundled the important thing challenges opposing value-based most cancers care by taking a look at an important elements of the care continuum and figuring out key developments that may affect innovation within the subsequent decade. Partially two, we’ll take a forward-looking view of the market and the way innovation will evolve following the trail of “disruptive innovation.”
The subsequent wave of most cancers care mannequin innovation will look a lot completely different than different specialty-specific illness administration startups equivalent to Livongo, Hinge Well being and others. Founders should proceed to deal with transcending episodic care supply to drive towards value-based care. However for most cancers care, this implies connecting earlier elements of the affected person journey, which embody bundling screening, diagnostics, training and nurse navigation providers with later-stage elements of the care continuum equivalent to remedy, ache administration, surgical care and distant upkeep.
Bettering our current care pathways by higher use of information will not be sufficient to shift conventional fee-for-service most cancers fashions in the direction of capitated or sub-capitated contracts.
“Delivering coordinated, high-value oncology care, tailor-made to every affected person’s distinctive medical presentation and private preferences is changing into more and more complicated for suppliers who should deal with quite a few utilization administration distributors when making diagnostic and remedy selections,” stated Dr. Ray Brig, vice chairman and medical director for oncology at Cohere Well being.
Moreover, deal with the affected person and creating consumer-centric platforms alone will not transfer the needle if the purpose is to drive collaboration throughout a number of stakeholders. Most cancers care requires sturdy, multidisciplinary coordination (throughout surgeons and suppliers) and stays an costly and lifelong battle for sufferers that always results in extreme monetary pressure. In the long term, organizations that develop correct end-to-end platforms and drive payer collaboration whereas concurrently bettering client and supplier expertise will win.
In abstract, we see three main developments that may drive most cancers affected person care administration innovation within the coming years:
With the arrival of digital well being options lately, now we have seen a fantastic unbundling of know-how and providers. Whereas new and higher level options will proceed to emerge, and necessary firms that supply specialised applied sciences or tech-enabled providers will probably be constructed, we consider platform gamers will probably be a key driver of innovation because of the added complexity and related value associated to managing and integrating a number of “best-in-class” level options. We see an analogous “re-bundling” in most cancers care the best way the computing trade has skilled a part of centralization.
“Within the historical past of the computing trade, as with most, the arrival of refined know-how usually drives the centralization of the trade as a result of the primary manifestation is so sophisticated and costly that solely folks with some huge cash and talent can personal it and use it,” defined Prof. Clayton Christensen.
At this time, solely probably the most refined organizations – massive well being programs, nationwide payers or deep-pocketed suppliers backed by traders – can afford the sources to guage and combine best-in-class digital well being providers. Whereas some most cancers sufferers and their family members will proceed to hunt options independently, most would favor to obtain care in an built-in vogue. Because of this, we foresee the rise of “platforms” that would manifest as a digital well being providers integrator and companion with most cancers care suppliers. We additionally see the rise of a brand new type of “cancer-focused” care suppliers that may actually handle the end-to-end journey of a most cancers affected person (together with elements of affected person engagement, monetary planning, medical staff/useful resource administration and contracting). Within the close to future, we might see the rise of ChenMed, Oak Avenue Well being or Iora Well being-like oncology clinics, in addition to Privia Well being or Agilon-like oncology aggregators and VBC-enablers.
In The Innovator’s Prescription, Christensen and Dr. Jason Hwang level out making use of know-how to outdated enterprise fashions has solely raised prices in healthcare and different industries. The most cancers care enterprise mannequin must evolve for digital well being innovation to be adopted extra rapidly. With the pattern towards re-bundling applied sciences and tech-enabled providers, we see that these platforms will even speed up the evolution of the enterprise mannequin.
Traditionally, healthcare has largely been paid for utilizing a fee-for-service (FFS) mannequin. Nonetheless, right this moment’s FFS mannequin is ill-equipped to reimburse suppliers and innovators for much-needed providers (e.g., care coordination, affected person engagement, affected person training) that would lead to higher outcomes and decrease complete medical expenditures. Whereas shifting oncology care towards value-based care is not one thing new (e.g., the Oncology Care Mannequin, an episode-based bundled cost mannequin developed by CMMI in 2016, and numerous personal payer oncology bundles), we consider superior analytics and affected person engagement/administration ushered by digital well being will present extra predictability and actionable insights to suppliers taking over the oncology VBC mannequin. The rising platform gamers or enablers will probably be contracted with payers in a VBC method.
Just like the computing trade, the method of innovation that led to the centralization of most cancers care will provoke a reciprocal means of decentralization. Simply as now we have seen within the decentralization of major care and care being moved from a facility to a affected person’s residence, we foresee oncology care following an analogous path.
We consider that oncology care is primed to be delivered within the consolation of the affected person’s residence. Most cancers sufferers are immunocompromised. The complication brought on by hospital-acquired infections or being uncovered to different sick sufferers might have profound monetary and consequence implications. Over the previous a number of years, now we have seen the emergence of decentralized medical trial firms that look to allow home-based medical trials. A number of beforehand talked about digital well being startups (e.g., residence phlebotomy) have laid the inspiration for home-based medical trial enablement. Moreover, the emergence of home-based infusion and hospital-at-home/SNF-at-home firms might basically drive the decentralization of most cancers care. As some extent of reference, roughly 800 sufferers (or 20% of the overall affected person served) served by Inbound Health previously two years have had most cancers as a major, secondary or tertiary prognosis. The day of managing complicated most cancers in a home-based setting and augmenting the beforehand talked about rising platforms might quickly be right here.
Concerning the Authors: Ian Chiang is a companion at Flare Capital Partners, a healthcare know-how and services-focused enterprise capital agency. Previous to becoming a member of Flare, he was the SVP of product and innovation and a founding member of CareAllies, Cigna’s household of multi-payer supplier providers, inhabitants well being administration, value-based care enablement and home-based care companies. Beforehand, he was a digital well being entrepreneur and a former administration guide at McKinsey & Firm.
Jonathon George is an MBA candidate at Kellogg Faculty of Administration and a Flare Capital Scholar. Whereas at Kellogg, he interned on the Mayo Clinic of their Oncology Division and at OCA Ventures as an investor. Beforehand, he was a administration guide at Chartis centered on well being programs and providers.
A particular because of Aaron Gerber, Dan McCarthy, Matt Bettonville, Ryan Langdale, Robin Shah, Shawn Morris and numerous others for offering their time and insights by a number of interviews. The staff at Flare interviewed 20+ executives, founders, traders, sufferers and leaders from throughout the nation on matters associated to oncology, innovation and tech-enabled providers for most cancers care supply. This text wouldn’t be potential with out their help.