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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.
That is half one in all a two-part collection on innovation in most cancers care supply. Partly one, we are going to talk about the complexity of end-to-end most cancers care administration, the unmet wants and the way some rising digital well being gamers tackle these issues. Partly two, we are going to spotlight the “subsequent wave” and rising traits of digital health-enabled most cancers care supply.
It is no secret: Most cancers is patently complicated.
Sufferers usually wrestle to understand the complexities of the U.S. well being system, and this confusion is usually amplified after a affected person receives a most cancers analysis. The Worldwide Company for Analysis on Most cancers forecasts the variety of new most cancers instances worldwide will attain greater than 29 million by 2040 in contrast with simply over 18 million in 2018. As therapy protocols advance and other people stay longer, typically conquering a number of cancers of their lifetime, the proper storm of power illness will rise and problem our healthcare system in quite a lot of methods.
With this improve within the variety of most cancers survivors, organizations have to be ready to deal with the following impacts of long-term toxicities, recurrence of most cancers, infertility points, cardiovascular side-effects and psychological aftereffects.
Whereas analysis reveals cancer has surpassed heart disease because the primary reason for loss of life in some high-income counties within the U.S., we have now not seen the identical progress and adoption of digital platforms for most cancers within the ways in which we have seen for different power illnesses equivalent to diabetes, musculoskeletal illness and power kidney illness. So why is not extra innovation occurring for most cancers care supply?
We search to reply this query by understanding the important thing challenges opposing value-based most cancers care, and unbundling crucial facets of care supply, to establish the important thing traits that may affect innovation for most cancers care within the subsequent decade.
Whereas tailwinds from COVID-19 and healthcare consumerism have pushed record-setting quantities of fundraising for early-stage digital well being startups over the past three years, main challenges exist for most cancers care supply that makes this space a very troublesome house to disrupt.
One purpose progressive care fashions equivalent to value-based and home-based care haven’t seen faster adoption lies within the problem related to integrating, and infrequently reintegrating, providers across the care group. As we proceed to innovate for most cancers care supply, organizations have to be considerate concerning the reintegration of care (e.g., level options). As well as, new options should empower the care groups to deliver the very best high quality instruments whereas additionally elevating affected person and supplier satisfaction — a troublesome steadiness to strike.
In talking with Aaron Gerber, CEO and cofounder of Reimagine Care, he famous the combination of correct instruments is not the one problem.
“When specialty medication, we have to think about each complexity [to administer the drug] and margin it generates for the healthcare system. We will then take a phased method that begins with the decrease complexity, decrease margin medication and increase over time, however solely after demonstrating success and elevated consolation with the affected person’s main oncology group,” he stated. “Achieved properly, this will increase affected person and supplier expertise whereas offering the chance to ship very high-quality house and digital care to sufferers.”
Level-solution fatigue for payers and suppliers, specialty drug buying and the danger of the perceived modifications’ impression on profitability for current enterprise fashions usually stifle collaboration throughout stakeholders. Capital depth related to creating these sturdy options, usually tied to platform improvement and the hiring prices for expert clinicians and care suppliers, stays a priority for early buyers as platforms scale. Different challenges embody the necessity to tightly combine surgical care into the answer to deal with larger acuity affected person populations. Add to that the widening disparity of take care of underserved and rural populations, historically served by group suppliers, and also you rapidly end up in a area of competing incentives and lagging enterprise fashions.
Key elements of the most cancers care continuum have been highlighted beneath to section an in any other case dastardly set of providers rendered throughout the affected person journey. Facets of the journey span the earliest stage of a affected person’s journey (equivalent to discount in solar publicity and tobacco use), to superior care and end-of-life care planning.
Whereas the best alternative to disrupt conventional enterprise fashions stays to be seen for most cancers care, startups have more and more tried to enter totally different components of the care continuum solely to run right into a slew of regulatory, incentive and integration hurdles imposed by incumbents within the house. As well as, the service-based facets equivalent to analysis, therapy, survivorship and end-of-life care require sturdy coordination round different facets equivalent to funds, schooling and household/caregiver help planning.
Innovation is starting to take form in numerous methods. Startups proceed to handle unmet wants by filling care gaps and supplementing current therapy types. Nevertheless, providers which have historically been non-revenue-generating appear to be a standard theme the place suppliers do not traditionally have the means to fund these initiatives, and payers are nonetheless too early in contracting for risk-based most cancers fashions. Whether or not startups can generate sustainable income within the short-term and reveal worth to stakeholders equivalent to well being methods and payers stays an open query.
Regardless of preserving facets of the biopharma and therapeutics house separate (we acknowledge there’s a a lot broader biotechnology and therapeutics marketplace for oncology, and quite a few corporations are driving innovation ahead), essentially the most outstanding startup exercise for care supply has been in diagnostic providers, therapy coordination and danger enablement.
On the sooner facet of the affected person continuum, prevention and danger discount options proceed to face a powerful headwind as organizations attempt to combine preventative and screening-based providers with their acute care counterparts. Balancing the fee-for-service nature of acute care supply with value-based preventative providers will probably be troublesome; aligning incentives will probably be important. We anticipate survivorship providers (most notably, group and diet providers) will proceed to combine extra tightly upstream with facets of acute care supply and recurrence prevention (e.g., screening, analysis).
On this market map, we spotlight a number of startups innovating throughout key classes. (See the broader Flare presentation here.)
Remedy: Leveraging information, care coordination and affected person help instruments to enhance choice making
Remedy is on the core of most cancers care supply, and we see numerous options being constructed throughout the class. A lot of the current most cancers therapy plans include three core providers: surgical intervention, systemic remedy and radiation therapy. Relying on the stage and presenting most cancers, surgical intervention is usually the primal type of therapy for early-stage diagnoses, and it is usually complemented or augmented with each systemic (chemo, hormone and immunotherapy) and radiation remedy.
Startups, nonetheless, are addressing challenges round therapy pathways in numerous methods, specializing in issues equivalent to navigation, coordination, therapy suggestions (for an knowledgeable client) and affected person help. We’ve additionally referred to as out house care, given the rise of at-home therapy choices (equivalent to house infusion remedy and lab assessments), though we acknowledge many facets of house care in oncology fall below different classes equivalent to screening and analysis.
The business has additionally seen a drastic improve within the availability of knowledge (e.g., claims, EMR, diagnostics, imaging) over the past twenty years to raised handle most cancers sufferers. Along with Flatiron Well being, there have been numerous information platforms, marketplaces (HealthVerity, Graphite Health) and analytics-ready information enablers (Mendel, Aetion) rising to make information extra accessible to researchers and clinicians. Nevertheless, many challenges nonetheless exist for clinicians managing their sufferers by means of an evidence-based method.
“Well being methods right now are sometimes not set as much as make choices based mostly on real-world information. Scientific trial information and different printed information is available, however organizations are starting to make the shift from the established order of printed proof (expertise-driven) to real-world proof (data-driven method) in medical apply,” stated Matt Bettonville, who leads Oncology Enterprise Investing at Emerson Collective.
Instruments that use real-world proof (RWE) to assist suppliers reply questions and supply clinical-decision help in a well timed method, each standalone corporations (e.g, Atropos Health) or these internally developed by well being methods and tutorial medical facilities, are anticipated to emerge within the coming years to drive extra customized therapy protocols.
The primary space we unbundle inside the therapy class is navigation.
Navigation
As know-how continues to embed itself throughout the most cancers care continuum, extra alternatives have arisen for know-how to bridge the hole between current therapy regimes and in the end present extra holistic and customized ranges of most cancers care. Even when core remedies aren’t basically altering (e.g., surgical intervention), sufferers and physicians can fine-tune facets of care to the affected person utilizing information and automation to help the administration of signs, negative effects, food plan monitoring, appointments, affected person funds and total coordination of in any other case disparate facets of care.
Navigation providers are in some ways the bedrock for sufferers navigating the complexities of care, and these providers play a important function to handle affected person’s largely unmet wants. Gamers equivalent to Jasper Health provide digital care administration instruments and a library of assets to help sufferers with every part from dealing with negative effects to monetary planning.
Care Coordination
Care coordination is a sizeable sub-category inside therapy that features choice help instruments to help physicians with managing affected person wants and, in concept, scale back administrative burden. One instance, Preveta, is a care coordination platform that takes illness protocols and interprets them into customized care navigation workflows. Via automated dashboards and refined information seize, methods goal to allow the clinician to seize further affected person information between visits. In flip, the software program will help assess the information and get it again into the fingers of the medical doctors rapidly to enhance therapy.
One other facet of care coordination consists of digital symptom administration, which sits on the intersection of distant monitoring instruments for patient-reported outcomes (e.g., Vinehealth, Reprosent) and proactive administration of signs by means of companion apps. As these startups scale, it turns into more and more vital to reveal improved affected person outcomes and ROI for purchasers (payers, suppliers) adopting the software program. Participating payers early additionally turns into an vital issue for organizations searching for to allow danger and handle bundled providers.
Alternatively, the route of accumulating and aggregating affected person information by means of digital affected person help instruments can turn into a pretty alternative for pharmaceutical corporations that search to faucet into distinctive affected person datapoints (equivalent to social determinants of well being), which will help inform drug adoption and adherence, medical trial enablement and a number of facets of drug improvement.
Remedy Suggestions and Affected person Assist
As affected person information turns into extra commoditized, and clinicians are inundated with the sheer quantity of knowledge and analysis publications that aren’t humanly potential to course of, medical choice help (CDS) instruments and next-generation analytics corporations that may present the “so-what” will play a central function in therapy advice and affected person administration.
Whereas Merative (previously IBM Watson Well being) and different CDS distributors primarily depend on publicly obtainable tips and analysis publications, a brand new class of digital well being startups augments current tips with real-world information (RWD) and real-world proof (RWE) to offer a extra data-driven means of treating most cancers sufferers.
“You want RWE and analytics and choice help that oncologists can get behind,” stated Dan McCarthy, CEO of New Century Well being and president of Evolent Well being.
Gamers equivalent to Atropos Well being present options that assist physicians reply beforehand unanswered medical questions utilizing real-world medical and administrative information in a well timed method. Digital well being corporations equivalent to Outcomes4Me and Ciitizen emerge and attempt to help most cancers sufferers of their journey to discovering the best therapy choices, and applicable medical trials, by means of schooling and affected person help.
Strains proceed to blur as supplier organizations search to create touchpoints earlier and earlier in a affected person’s journey by establishing digital entrance doorways, and alternatively, pharmaceutical corporations search to realize entry to extra longitudinal information to help decision-making.
House-Primarily based Most cancers Care
The shift to home-based take care of most cancers has been in improvement for over a decade, however the current modifications within the regulatory setting have enabled sure types of remedy to be administered within the consolation of a affected person’s house. Key modifications, spawned partly by COVID-19, embody the elevated adoption and want for care administered within the house, and growing pressures on the system on account of rising prices in key areas of spend (together with musculoskeletal, most cancers and renal).
Gamers like Reimagine Care and Karkonos are tackling house infusions, lab attracts and digital visits with the aim of creating care extra reasonably priced and extra accessible. Whereas others equivalent to Inbound Health and Medically Home are enabling well being methods to manage hospital-at-home for medium- and high-acuity sufferers, though the prime focus could not all the time be solely on most cancers sufferers.
Questions stay across the degree of involvement that well being methods and payers could have within the growth of house well being typically. Whereas it’s nonetheless unclear precisely how and the place well being methods and AMCs will combine into the broader ecosystem, startups are starting to reveal (and justify) a key understanding of value when creating these home-based capabilities for most cancers.
As startups proceed to make progress in sure areas of the therapy pathway, we count on to see increasingly well being methods and payers searching for partnerships with exterior organizations as they increase their hospital-at-home and home-based providers.
Enablement and Threat-Bearing Entities: An effort to basically shift the enterprise mannequin of most cancers care to worth
Prior to now, oncologists have been fairly nervous about taking dangers, even professionally, on account of anxiousness round specialty drug prices. For many medical teams, the know-how wants are additionally too daunting as too many level options are sometimes wanted to correctly handle populations. Payers are additionally nonetheless within the state of transitioning, as disagreement across the degree of inclusion for specialty drug prices usually leads to a rate-limiting step for contracting.
Whereas challenges persist, current traits have enabled increasingly oncology teams to start shifting towards danger. As Shawn Morris, CEO of Privia Well being, stated, “When requested concerning the chance by buyers and analysts, there are a number of specialties which might be excessive quantity and might underwrite the danger from an actuarial standpoint in Medicare —orthopedics, GI, urology, ophthalmology and oncology. The success of shifting into value-based preparations and danger relies on correct alignment with physicians and payers and having the mandatory instruments, expertise and know-how (information) to handle danger.”
Alternatives are increasing for startups and oncology teams to begin with skilled capitation and in the end transfer upstream. These preparations are principally seen within the Medicare Benefit house, and as organizations proceed to reveal improved outcomes, business alternatives could quickly be on the horizon.
“Success in bearing danger is feasible for those who design the best methodology,” Robin Shah, CEO and cofounder of Thyme Care, stated. “This requires a deep understanding of the affected person past their medical components, and to construct that understanding it’s essential develop trusted relationships with members. With out these relationships in place, you received’t be capable of affect conduct change.”
Completely different Approaches
We see innovation in danger enablement taking many types. Whether or not it’s corporations equivalent to Transcarent (e.g., lately introduced Transcarent Oncology Care) searching for to overtake the employer self-insured enterprise or corporations taking a data-driven method to bettering broader affected person care pathways, specializing in facets equivalent to tumor boards, many enablement platforms are rising that drive collaboration throughout sufferers, suppliers and payers. Different gamers, equivalent to Azra AI, are utilizing synthetic intelligence to interpret information in real-time to tell analysis by means of care administration. Thyme Care presents a nursing-led platform that’s outfitted with information and analytics to proactively help most cancers sufferers’ choice making and coordination all through the method. Cohere Health appears to align medical and monetary choices holistically throughout an oncology affected person’s care journey, enabling higher collaboration and decision-making in direction of high-value care.
If arrange appropriately, enablement platforms have the potential to supply a brand new method to navigate members to high-quality, low-cost care, even when meaning shifting them to one of the best and least costly facility in a patient-friendly means. Latest enterprise fashions have an vital cost-focused distinction that’s basically totally different in some ways in contrast with the normal, revenue-focused actions launched by massive most cancers facilities within the early 2010s (e.g., CTCA collaborates to provide free air transportation for cancer patients) that had been usually established to develop an current supplier’s footprint.
In abstract, a elementary shift from historic most cancers care enterprise fashions should happen so digital well being innovation might be adopted extra rapidly. With the emergence of re-bundling applied sciences and tech-enabled providers, we count on the progress of risk-bearing and risk-enablement platforms to be a key facet for accelerating the evolution of the most cancers enterprise mannequin.
Screening and Prognosis: Tech developments and home-enabled providers producing distinctive entry factors
Early most cancers screening and analysis can usually be the distinction between life and loss of life for most cancers sufferers. In response to the American Most cancers Society, the 5-year relative survival rate between two colon most cancers sufferers, one on the “localized” SEER stage (91%) and one on the “distant” SEER stage (14%), is staggering. The significance of early screening and detection of most cancers is well-established and well-known to clinicians and sufferers alike.
Over the previous twenty years, outstanding enhancements in applied sciences have allowed physicians to search out most cancers at an early stage, lengthy earlier than signs seem. From higher imaging procedures to numerous breakthrough diagnostic assessments (e.g., liquid biopsy, single-cell genomic testing, multi-OMICs), the power to display screen and diagnose cancers has taken a large leap ahead.
Diagnostics
Important enhancements in sequencing know-how and price led to the rise of corporations like GRAIL, which pitches a multi-cancer early detection take a look at that may display screen over 50 kinds of most cancers by means of a single blood draw for roughly $1,000. Along with bettering novel screening and diagnostic assessments, private and non-private sectors have additionally completed their justifiable share of elevating most cancers screening consciousness and bettering entry. From numerous most cancers screening campaigns from the personal sector and non-profits to CMS making a number of most cancers screening (e.g., breast most cancers, colorectal most cancers) a part of the Medicare Half C Star Rankings measurement, screening and detection play a entrance and middle function on this evolution of most cancers care.
Whereas vital technological and coverage enhancements have been made, many unmet wants nonetheless exist. Obstacles embody transportation to diagnostic websites, lengthy wait occasions for specialists and entry to genetic counselors. Digital well being innovators can play an important function in addressing these unmet wants. From a affected person entry to screening standpoint, we have now seen non-invasive, home-based diagnostic assessments, equivalent to Cologuard, which might be getting used and promoted by payers over the previous decade (e.g., Humana to cover Cologuard for colorectal cancer screening).
Modern digital well being and home-based diagnostics corporations (e.g., EverlyWell) have emerged over the previous decade to enhance entry to diagnostic assessments that may be completed at point-of-care or with samples collected at house. It isn’t inconceivable that platforms like EverlyWell will transfer past well being and wellness assessments and use their person base to enhance most cancers screening and detection. Different rising gamers that may dramatically scale back entry limitations embody house phlebotomy corporations (e.g., GetLabs, Sprinter Health) that would make the blood draw extra accessible. They’ll additionally help in ongoing affected person administration for these sufferers who’re in the end identified with most cancers and could possibly be enrolled in home-based most cancers administration and medical trials.
Schooling
Educating sufferers on the impression of medical therapy and way of life change stays a largely unmet want, no matter affected person acuity or circumstance. Most cancers facilities have taken a proactive step over the past twenty years to offer schooling instruments and providers to equip the sufferers with extra info (together with the rise of tech-enabled directories e.g., Mayo Clinic’s online resources and library), however outcomes can usually be described as “info overload,” inflicting sufferers to really feel overwhelmed.
Systematic reviews for superior most cancers sufferers and casual caregivers (e.g., partner, relations) have three frequent areas of unmet want: psychological, bodily and healthcare providers info.
Among the greatest academic gaps for sufferers lie in the advantages and negative effects of therapy in addition to way of life modifications, each after the preliminary analysis and when transitioning from lively therapy to survivorship. Schooling and care coordination startups are beginning to emerge that empower their sufferers with instruments equivalent to automated facet impact help (e.g., Ankr) that may help in ongoing, asynchronous affected person administration to offer vital power administration and inhabitants well being information.
Survivorship: An emergence of digital-hybrid communities and diet help to assist with a affected person’s altering way of life
Sufferers will want extra individualized help as therapy and affected person administration turn out to be extra focused and customized. In right now’s social media-connected world, most cancers sufferers search to narrate to sufferers like them. First-generation, patient-focused social networking websites like PatientsLikeMe emerged within the 2000s, whereas new affected person communities equivalent to Inspire and This is Living With Cancer have emerged to offer group help and steerage on therapy choices in more moderen years.
Along with peer help networks, expert-guided digital clinics, equivalent to VivorCare, have emerged to supply custom-made help and tailor-made packages that assist most cancers survivors handle their care exterior the hospital setting, beginning with packages designed for psychological well being. Diet-as-medicine continues to take off, and whereas many startups are specializing in gastrointestinal care (in lots of instances, beginning with IBD and IBS sufferers), startups are rising (Savor Nutrition, Season Health) which might be properly positioned to fill the hole for oncology sufferers with food-as-medicine, much like how these gamers are managing sufferers with power illnesses equivalent to diabetes.
In regards to the Authors: Ian Chiang is a accomplice 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 advisor 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 advisor at Chartis centered on well being methods and providers.
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 by means of a number of interviews. The group at Flare interviewed 20+ executives, founders, buyers, 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.
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