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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.
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 immediately’s unmet wants. We unbundled the important thing challenges opposing value-based most cancers care by taking a look at a very powerful features of the care continuum and figuring out key developments that can affect innovation within the subsequent decade. Partly 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 totally different than different specialty-specific illness administration startups similar to Livongo, Hinge Well being and others. Founders should proceed to concentrate on transcending episodic care supply to drive towards value-based care. However for most cancers care, this implies connecting earlier features of the affected person journey, which embrace bundling screening, diagnostics, schooling and nurse navigation providers with later-stage features of the care continuum similar to remedy, ache administration, surgical care and distant upkeep.
Bettering our current care pathways by way of 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 turning into more and more complicated for suppliers who should cope with quite a few utilization administration distributors when making diagnostic and remedy choices,” stated Dr. Ray Brig, vice chairman and medical director for oncology at Cohere Well being.
Moreover, concentrate on the affected person and creating consumer-centric platforms alone will not transfer the needle if the objective is to drive collaboration throughout a number of stakeholders. Most cancers care requires strong, 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 shopper and supplier expertise will win.
In abstract, we see three main developments that can 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 awesome 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 might be constructed, we imagine platform gamers might be a key driver of innovation as a result of 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 way in which the computing trade has skilled a section of centralization.
“Within the historical past of the computing trade, as with most, the appearance of subtle know-how usually drives the centralization of the trade 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.
As we speak, solely probably the most subtle organizations – massive well being programs, nationwide payers or deep-pocketed suppliers backed by buyers – can afford the assets 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 style. In consequence, we foresee the rise of “platforms” that might manifest as a digital well being providers integrator and accomplice with most cancers care suppliers. We additionally see the rise of a brand new type of “cancer-focused” care suppliers that may really handle the end-to-end journey of a most cancers affected person (together with features of affected person engagement, monetary planning, medical crew/useful resource administration and contracting). Within the close to future, we might see the rise of ChenMed, Oak Road 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 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. Nevertheless, immediately’s FFS mannequin is ill-equipped to reimburse suppliers and innovators for much-needed providers (e.g., care coordination, affected person engagement, affected person schooling) that might lead to higher outcomes and decrease complete medical expenditures. Whereas transferring oncology care towards value-based care is not one thing new (e.g., the Oncology Care Mannequin, an episode-based bundled fee mannequin developed by CMMI in 2016, and varied personal 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 over the oncology VBC mannequin. The rising platform gamers or enablers might 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 technique of decentralization. Simply as we have now seen within the decentralization of major care and care being moved from a facility to a affected person’s dwelling, 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 dwelling. Most cancers sufferers are immunocompromised. The complication attributable to hospital-acquired infections or being uncovered to different sick sufferers might have profound monetary and final result implications. Over the previous a number of years, we have now 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., dwelling 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 a degree 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.
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 targeted on well being programs 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 way of a number of interviews. The crew 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 assist.
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