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 right here.
Partially one in every of this text, we highlighted the varied parts of end-to-end most cancers care supply and administration and the way innovators have emerged to deal with at this time’s unmet wants. We unbundled the important thing challenges opposing value-based most cancers care by taking a look at crucial elements of the care continuum and figuring out key traits that may affect innovation within the subsequent decade. Partially two, we are going to 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 totally different than different specialty-specific illness administration startups comparable to Livongo, Hinge Well being and others. Founders should proceed to give attention to 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 embrace bundling screening, diagnostics, training and nurse navigation companies with later-stage elements of the care continuum comparable to therapy, ache administration, surgical care and distant upkeep.
Bettering our present care pathways via 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 scientific presentation and private preferences is changing into more and more complicated for suppliers who should cope with quite a few utilization administration distributors when making diagnostic and therapy selections,” stated Dr. Ray Brig, vice chairman and medical director for oncology at Cohere Well being.
Moreover, give attention to the affected person and growing consumer-centric platforms alone will not transfer the needle if the aim 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 usually 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 traits that may drive most cancers affected person care administration innovation within the coming years:
With the appearance of digital well being options in recent times, we have now seen an ideal unbundling of know-how and companies. Whereas new and higher level options will proceed to emerge, and essential corporations that supply specialised applied sciences or tech-enabled companies can be constructed, we imagine platform gamers can 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 the same “re-bundling” in most cancers care the best way the computing business has skilled a section of centralization.
“Within the historical past of the computing business, as with most, the appearance of subtle know-how sometimes drives the centralization of the business as a result of the primary manifestation is so sophisticated and costly that solely individuals with some huge cash and talent can personal it and use it,” defined Prof. Clayton Christensen.
At the moment, solely essentially the most subtle organizations – giant well being methods, nationwide payers or deep-pocketed suppliers backed by buyers – can afford the sources to guage and combine best-in-class digital well being companies. Whereas some most cancers sufferers and their family members will proceed to hunt options independently, most would like 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 companies 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, scientific staff/useful resource administration and contracting). Within the close to future, we may 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 previous 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 shortly. With the development towards re-bundling applied sciences and tech-enabled companies, 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. Nevertheless, at this time’s FFS mannequin is ill-equipped to reimburse suppliers and innovators for much-needed companies (e.g., care coordination, affected person engagement, affected person training) that would end in higher outcomes and decrease whole 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 varied non-public payer oncology bundles), we imagine superior analytics and affected person engagement/administration ushered by digital well being will present extra predictability and actionable insights to suppliers taking up the oncology VBC mannequin. The rising platform gamers or enablers can be contracted with payers in a VBC method.
Just like the computing business, the method of innovation that led to the centralization of most cancers care will provoke a reciprocal means of decentralization. Simply as we have now seen within the decentralization of main care and care being moved from a facility to a affected person’s residence, we foresee oncology care following the same path.
We imagine 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 may have profound monetary and consequence implications. Over the previous a number of years, we have now seen the emergence of decentralized scientific trial corporations that look to allow home-based scientific trials. A number of beforehand talked about digital well being startups (e.g., residence phlebotomy) have laid the inspiration for home-based scientific trial enablement. Moreover, the emergence of home-based infusion and hospital-at-home/SNF-at-home corporations may basically drive the decentralization of most cancers care. As some extent of reference, roughly 800 sufferers (or 20% of the full affected person served) served by Inbound Well being up to now two years have had most cancers as a main, secondary or tertiary analysis. The day of managing complicated most cancers in a home-based setting and augmenting the beforehand talked about rising platforms may quickly be right here.
Concerning the Authors: Ian Chiang is a companion at Flare Capital Companions, 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 companies, 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 methods and companies.
A particular due to Aaron Gerber, Dan McCarthy, Matt Bettonville, Ryan Langdale, Robin Shah, Shawn Morris and numerous others for offering their time and insights via a number of interviews. The staff at Flare interviewed 20+ executives, founders, buyers, sufferers and leaders from throughout the nation on matters associated to oncology, innovation and tech-enabled companies for most cancers care supply. This text wouldn’t be attainable with out their assist.