Contribution: The future of digital cancer care

Disclaimer: Flare Capital Partners is an investor in Aetion, Cohere Health, HealthVerity, Inbound Health, Iora Health and ViverCare. See Flare’s larger presentation here.

In first part of this article, we highlighted the various components of end-to-end cancer care delivery and management and how innovators have emerged to address today’s unmet needs. We’ve unbundled the key challenges that stand in the way of value-based cancer care by examining the most important aspects of the continuum of care and identifying key trends that will influence innovation over the next decade. In the second part, we will carry a prospective vision of the market and the evolution of innovation following the path of “disruptive innovation”.

The next wave of innovation in cancer care models will be very different from other specialty-specific disease management startups such as Livongo, Hinge Health and others. Founders must continue to focus on moving beyond providing episodic care to moving towards value-based care. But for cancer care, it means linking the early aspects of the patient journey, which include bringing together screening, diagnostic, education, and nurse navigation services with later aspects of the continuum of care such as treatment , pain management, surgical care and remote maintenance.

Improving our existing care pathways through better use of data will not be enough to shift traditional fee-for-service cancer models towards funded or underfunded contracts.

“Delivering coordinated, high-value cancer care tailored to each patient’s unique clinical presentation and personal preferences is becoming increasingly complex for providers who must deal with multiple utilization management vendors when they make diagnostic and treatment decisions,” said Dr. Ray Brig, vice president and medical director of oncology at Cohere Health.

Moreover, focusing on the patient and developing consumer-centric platforms will not be enough to get things done if the goal is to foster collaboration between multiple stakeholders. Cancer care requires strong multidisciplinary coordination (between surgeons and providers) and remains a costly and ongoing battle for patients, often resulting in severe financial hardship. In the long run, organizations that develop appropriate end-to-end platforms and encourage payer collaboration while simultaneously improving the consumer and provider experience will be winners.

In summary, we see three major trends that will drive innovation in the management of cancer patient care in the years to come:

With the advent of digital health solutions in recent years, we have seen a great unbundling of technology and services. As new and better point solutions will continue to emerge and significant companies offering specialized technologies or technology services will be created, we believe that platform players will be a key driver of innovation due to the added complexity and associated costs of managing and integrating multiple best-in-class point solutions. We are seeing a similar “consolidation” in cancer care in the same way that the IT industry went through a phase of centralization.

“In the history of the computer industry, as in most cases, the advent of sophisticated technology usually leads to the centralization of the industry because the first manifestation is so complicated and expensive that only people with a lot of of money and skills can own and use it,” explained Prof. Clayton Christensen.

Today, only the most sophisticated organizations—large health systems, national payers, or deep-pocketed, investor-backed providers—can afford the resources to evaluate and integrate the best digital health services. While some cancer patients and their loved ones will continue to seek solutions independently, most would prefer to receive care in an integrated manner. Accordingly, we anticipate the rise of “platforms” that could manifest as an integrator of digital health services and partnership with cancer care providers. We are also seeing the rise of a new breed of “cancer-centric” care providers who can truly manage a cancer patient’s journey from start to finish (including aspects of patient engagement, financial planning, clinical team/resource management and contracts) . In the near future, we may see the rise of oncology clinics like ChenMed, Oak Street Health, or Iora Health, as well as oncology aggregators like Privia Health or Agilon, and VBC activators.

In The innovator’s prescription, Christensen and Dr. Jason Hwang point out that applying technology to old business models has only increased costs in healthcare and other industries. The economic model of cancer care must evolve so that digital health innovation is adopted more quickly. With the trend of bundling technologies and technology-based services, we see that these platforms will also accelerate the evolution of the business model.

Historically, health care has largely been paid for using a fee-for-service (FFS) model. However, the current FFS model is ill-equipped to reimburse providers and innovators for much-needed services (e.g. care coordination, patient engagement, patient education) that could lead to better outcomes and reduced costs. total medical expenses. Although the evolution of cancer care towards value-based care is not something new (for example, the cancer care model, an episode-based bundled payment model developed by CMMI in 2016, and various Private Pay Oncology Clinics), we believe the advanced analytics and patient engagement/management ushered in by digital health will provide more predictability and actionable insights to providers embracing the VBC model in oncology. Emerging platform actors or facilitators will be contracted with payers in a VBC manner.

Like the computer industry, the process of innovation that led to the centralization of cancer care will initiate a reciprocal process of decentralization. Just as we have seen with the decentralization of primary care and the movement of care from a facility to a patient’s home, we anticipate that cancer care will follow a similar path.

We believe that oncology care should be delivered in the comfort of the patient’s home. Cancer patients are immunocompromised. The complication caused by nosocomial infections or exposure to other ill patients could have profound financial and outcome implications. In recent years, we have seen the emergence of decentralized clinical trial companies seeking to enable home-based clinical trials. Several previously mentioned digital health startups (e.g., home phlebotomy) have laid the groundwork for enabling clinical trials at home. Moreover, the emergence of home infusion and home hospitalization/home SNF companies could fundamentally lead to the decentralization of cancer care. For reference, approximately 800 patients (or 20% of the total number of patients served) served by Incoming Health in the past two years have had cancer as their primary, secondary or tertiary diagnosis. The day of complex cancer management in a home setting and the rise of previously mentioned emerging platforms may soon be here.

About the authors: Ian Chiang is a partner at Flare Capital Partners, a venture capital firm focused on healthcare technologies and services. Prior to joining Flare, he was senior vice president of product and innovation and a founding member of CareAllies, Cigna’s family of multipayer provider services, population health management, patient-based care enablement value and home care business. Previously, he was a digital health entrepreneur and former management consultant at McKinsey & Company.

Jonathon George is an MBA candidate at the Kellogg School of Management and Flare Capital Scholar. While at Kellogg, he interned at the Mayo Clinic in their oncology division and at OCA Ventures as an investor. Previously, he was a management consultant at Chartis, specializing in health systems and services.

Special thanks to Aaron Gerber, Dan McCarthy, Matt Bettonville, Ryan Langdale, Robin Shah, Shawn Morris and countless others for contributing their time and insights through multiple interviews. Flare’s team interviewed more than 20 executives, founders, investors, patients and executives from across the country on topics related to oncology, innovation and technology services for cancer care delivery. This article would not be possible without their support.