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.
That is half one in all a two-part collection on innovation in most cancers care supply. Partly one, we’ll talk about the complexity of end-to-end most cancers care administration, the unmet wants and the way some rising digital well being gamers deal with these considerations. Partly two, we’ll spotlight the “subsequent wave” and rising developments of digital health-enabled most cancers care supply.
It is no secret: Most cancers is patently complicated.
Sufferers usually battle to know the complexities of the U.S. well being system, and this confusion is commonly 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 remedy protocols advance and folks dwell longer, typically conquering a number of cancers of their lifetime, the proper storm of continual 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 most cancers has surpassed coronary heart illness because the primary explanation for dying in some high-income counties within the U.S., now we have not seen the identical progress and adoption of digital platforms for most cancers within the ways in which we have seen for different continual ailments reminiscent of diabetes, musculoskeletal illness and continual 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 elements of care supply, to determine the important thing developments that can 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 tough house to disrupt.
One purpose progressive care fashions reminiscent of value-based and home-based care haven’t seen faster adoption lies within the problem related to integrating, and infrequently reintegrating, companies across the care staff. 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 carry the very best high quality instruments whereas additionally elevating affected person and supplier satisfaction — a troublesome stability 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 taking a look at specialty medicine, we have to contemplate each complexity [to administer the drug] and margin it generates for the healthcare system. We are able to then take a phased strategy that begins with the decrease complexity, decrease margin medicine and develop over time, however solely after demonstrating success and elevated consolation with the affected person’s main oncology staff,” 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 present enterprise fashions usually stifle collaboration throughout stakeholders. Capital depth related to creating these strong options, usually tied to platform growth 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 neighborhood suppliers, and also you rapidly end up in a discipline of competing incentives and lagging enterprise fashions.
Key elements of the most cancers care continuum have been highlighted under to section an in any other case dastardly set of companies rendered throughout the affected person journey. Elements of the journey span the earliest stage of a affected person’s journey (reminiscent of 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 elements reminiscent of analysis, remedy, survivorship and end-of-life care require sturdy coordination round different elements reminiscent of funds, training and household/caregiver assist planning.
Innovation is starting to take form in several methods. Startups proceed to handle unmet wants by filling care gaps and supplementing present remedy varieties. Nonetheless, companies 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 exhibit worth to stakeholders reminiscent of well being programs and payers stays an open query.
Regardless of retaining elements 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), probably the most distinguished startup exercise for care supply has been in diagnostic companies, remedy coordination and threat enablement.
On the sooner aspect of the affected person continuum, prevention and threat discount options proceed to face a robust headwind as organizations attempt to combine preventative and screening-based companies with their acute care counterparts. Balancing the fee-for-service nature of acute care supply with value-based preventative companies shall be tough; aligning incentives shall be crucial. We anticipate survivorship companies (most notably, neighborhood and diet companies) will proceed to combine extra tightly upstream with elements 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 right here.)
Remedy: Leveraging knowledge, care coordination and affected person assist instruments to enhance determination making
Remedy is on the core of most cancers care supply, and we see varied options being constructed throughout the class. A lot of the present most cancers remedy plans include three core companies: surgical intervention, systemic remedy and radiation remedy. Relying on the stage and presenting most cancers, surgical intervention is commonly the primal type of remedy for early-stage diagnoses, and it is usually complemented or augmented with each systemic (chemo, hormone and immunotherapy) and radiation remedy.
Startups, nevertheless, are addressing challenges round remedy pathways in several methods, specializing in issues reminiscent of navigation, coordination, remedy suggestions (for an knowledgeable client) and affected person assist. We’ve additionally referred to as out house care, given the rise of at-home remedy choices (reminiscent of house infusion remedy and lab checks), though we acknowledge many elements of house care in oncology fall below different classes reminiscent of screening and analysis.
The trade has additionally seen a drastic improve within the availability of information (e.g., claims, EMR, diagnostics, imaging) over the past 20 years to higher handle most cancers sufferers. Along with Flatiron Well being, there have been varied knowledge platforms, marketplaces (HealthVerity, Graphite Well being) and analytics-ready knowledge enablers (Mendel, Aetion) rising to make knowledge extra accessible to researchers and clinicians. Nonetheless, many challenges nonetheless exist for clinicians managing their sufferers via an evidence-based strategy.
“Well being programs at the moment are sometimes not set as much as make choices primarily based on real-world knowledge. Medical trial knowledge and different printed knowledge 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 strategy) in scientific observe,” 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 assist in a well timed method, each standalone corporations (e.g, Atropos Well being) or these internally developed by well being programs and educational medical facilities, are anticipated to emerge within the coming years to drive extra personalised remedy protocols.
The primary space we unbundle throughout the remedy class is 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 present remedy regimes and in the end present extra holistic and personalised ranges of most cancers care. Even when core remedies aren’t basically altering (e.g., surgical intervention), sufferers and physicians can fine-tune elements of care to the affected person utilizing knowledge and automation to assist the administration of signs, unwanted effects, weight-reduction plan monitoring, appointments, affected person funds and total coordination of in any other case disparate elements of care.
Navigation companies are in some ways the bedrock for sufferers navigating the complexities of care, and these companies play a crucial function to handle affected person’s largely unmet wants. Gamers reminiscent of Jasper Well being supply digital care administration instruments and a library of sources to help sufferers with every part from dealing with unwanted effects to monetary planning.
Care coordination is a sizeable sub-category inside remedy that features determination assist instruments to help physicians with managing affected person wants and, in principle, cut back administrative burden. One instance, Preveta, is a care coordination platform that takes illness protocols and interprets them into personalised care navigation workflows. By means of automated dashboards and refined knowledge seize, programs goal to allow the clinician to seize extra affected person knowledge between visits. In flip, the software program may help assess the information and get it again into the arms of the docs rapidly to enhance remedy.
One other aspect 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 via companion apps. As these startups scale, it turns into more and more essential to exhibit improved affected person outcomes and ROI for purchasers (payers, suppliers) adopting the software program. Partaking payers early additionally turns into an essential issue for organizations searching for to allow threat and handle bundled companies.
Alternatively, the route of amassing and aggregating affected person knowledge via digital affected person assist instruments can become a gorgeous alternative for pharmaceutical corporations that search to faucet into distinctive affected person datapoints (reminiscent of social determinants of well being), which may help inform drug adoption and adherence, scientific trial enablement and a number of elements of drug growth.
Remedy Suggestions and Affected person Assist
As affected person knowledge turns into extra commoditized, and clinicians are inundated with the sheer quantity of information and analysis publications that aren’t humanly attainable to course of, scientific determination assist (CDS) instruments and next-generation analytics corporations that may present the “so-what” will play a central function in remedy suggestion and affected person administration.
Whereas Merative (previously IBM Watson Well being) and different CDS distributors primarily depend on publicly accessible pointers and analysis publications, a brand new class of digital well being startups augments present pointers with real-world knowledge (RWD) and real-world proof (RWE) to supply a extra data-driven manner of treating most cancers sufferers.
“You want RWE and analytics and determination assist that oncologists can get behind,” stated Dan McCarthy, CEO of New Century Well being and president of Evolent Well being.
Gamers reminiscent of Atropos Well being present options that assist physicians reply beforehand unanswered scientific questions utilizing real-world scientific and administrative knowledge in a well timed method. Digital well being corporations reminiscent of Outcomes4Me and Ciitizen emerge and attempt to assist most cancers sufferers of their journey to discovering the fitting remedy choices, and applicable scientific trials, via training and affected person assist.
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 knowledge to assist decision-making.
House-Based mostly Most cancers Care
The shift to home-based take care of most cancers has been in growth for over a decade, however the latest modifications within the regulatory atmosphere have enabled sure types of remedy to be administered within the consolation of a affected person’s house. Key modifications, spawned partially by COVID-19, embody the elevated adoption and wish for care administered within the house, and rising pressures on the system as a consequence 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 purpose of constructing care extra reasonably priced and extra accessible. Whereas others reminiscent of Inbound Well being and Medically House are enabling well being programs to manage hospital-at-home for medium- and high-acuity sufferers, though the prime focus might not all the time be completely on most cancers sufferers.
Questions stay across the stage of involvement that well being programs and payers can have within the enlargement of house well being usually. Whereas it’s nonetheless unclear precisely how and the place well being programs and AMCs will combine into the broader ecosystem, startups are starting to exhibit (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 remedy pathway, we count on to see an increasing number of well being programs and payers searching for partnerships with outdoors organizations as they develop their hospital-at-home and home-based companies.
Enablement and Danger-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, as a consequence 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 stage of inclusion for specialty drug prices usually ends in a rate-limiting step for contracting.
Whereas challenges persist, latest developments have enabled an increasing number of oncology teams to start transferring towards threat. As Shawn Morris, CEO of Privia Well being, stated, “When requested concerning the risk by buyers and analysts, there are a couple of specialties which are excessive quantity and may underwrite the danger from an actuarial standpoint in Medicare —orthopedics, GI, urology, ophthalmology and oncology. The success of transferring into value-based preparations and threat relies on correct alignment with physicians and payers and having the required instruments, expertise and know-how (knowledge) to handle threat.”
Alternatives are increasing for startups and oncology teams to begin with skilled capitation and in the end transfer upstream. These preparations are largely seen within the Medicare Benefit house, and as organizations proceed to exhibit improved outcomes, industrial alternatives might quickly be on the horizon.
“Success in bearing threat is feasible in case you design the fitting methodology,” Robin Shah, CEO and cofounder of Thyme Care, stated. “This requires a deep understanding of the affected person past their scientific elements, and to construct that understanding it’s good to develop trusted relationships with members. With out these relationships in place, you gained’t have the ability to affect habits change.”
Totally different Approaches
We see innovation in threat enablement taking many varieties. Whether or not it’s corporations reminiscent of Transcarent (e.g., lately introduced Transcarent Oncology Care) searching for to overtake the employer self-insured enterprise or corporations taking a data-driven strategy to bettering broader affected person care pathways, specializing in elements reminiscent of tumor boards, many enablement platforms are rising that drive collaboration throughout sufferers, suppliers and payers. Different gamers, reminiscent of Azra AI, are utilizing synthetic intelligence to interpret knowledge in real-time to tell analysis via care administration. Thyme Care gives a nursing-led platform that’s geared up with knowledge and analytics to proactively assist most cancers sufferers’ determination making and coordination all through the method. Cohere Well being seems to be to align scientific 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 technique to navigate members to high-quality, low-cost care, even when meaning transferring them to the most effective and least costly facility in a patient-friendly manner. Current enterprise fashions have an essential cost-focused distinction that’s basically totally different in some ways in contrast with the normal, revenue-focused actions launched by giant most cancers facilities within the early 2010s (e.g., CTCA collaborates to supply free air transportation for most cancers sufferers) that have been usually established to develop an present supplier’s footprint.
In abstract, a elementary shift from historic most cancers care enterprise fashions should happen so digital well being innovation will be adopted extra rapidly. With the emergence of re-bundling applied sciences and tech-enabled companies, 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 Analysis: Tech developments and home-enabled companies producing distinctive entry factors
Early most cancers screening and analysis can usually be the distinction between life and dying for most cancers sufferers. Based on the American Most cancers Society, the 5-year relative survival price 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 20 years, outstanding enhancements in applied sciences have allowed physicians to seek out most cancers at an early stage, lengthy earlier than signs seem. From higher imaging procedures to varied breakthrough diagnostic checks (e.g., liquid biopsy, single-cell genomic testing, multi-OMICs), the flexibility to display screen and diagnose cancers has taken a large leap ahead.
Vital enhancements in sequencing know-how and value led to the rise of corporations like GRAIL, which pitches a multi-cancer early detection check that may display screen over 50 kinds of most cancers via a single blood draw for roughly $1,000. Along with bettering novel screening and diagnostic checks, private and non-private sectors have additionally finished their justifiable share of elevating most cancers screening consciousness and bettering entry. From varied 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. Limitations embody transportation to diagnostic websites, lengthy wait occasions for specialists and entry to genetic counselors. Digital well being innovators can play a vital function in addressing these unmet wants. From a affected person entry to screening standpoint, now we have seen non-invasive, home-based diagnostic checks, reminiscent of Cologuard, which are getting used and promoted by payers over the previous decade (e.g., Humana to cowl Cologuard for colorectal most cancers screening).
Progressive digital well being and home-based diagnostics corporations (e.g., EverlyWell) have emerged over the previous decade to enhance entry to diagnostic checks that may be finished 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 checks and use their consumer base to enhance most cancers screening and detection. Different rising gamers that can dramatically cut back entry limitations embody house phlebotomy corporations (e.g., GetLabs, Sprinter Well being) 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 recognized with most cancers and may very well be enrolled in home-based most cancers administration and scientific trials.
Educating sufferers on the impression of scientific remedy and life-style change stays a largely unmet want, no matter affected person acuity or circumstance. Most cancers facilities have taken a proactive step over the past 20 years to supply training instruments and companies to equip the sufferers with extra data (together with the rise of tech-enabled directories e.g., Mayo Clinic’s on-line sources and library), however outcomes can usually be described as “data overload,” inflicting sufferers to really feel overwhelmed.
Systematic opinions for superior most cancers sufferers and casual caregivers (e.g., partner, relations) have three frequent areas of unmet want: psychological, bodily and healthcare companies data.
A number of the greatest instructional gaps for sufferers lie in the advantages and unwanted effects of remedy in addition to life-style modifications, each after the preliminary analysis and when transitioning from lively remedy to survivorship. Schooling and care coordination startups are beginning to emerge that empower their sufferers with instruments reminiscent of automated aspect impact assist (e.g., Ankr) that may help in ongoing, asynchronous affected person administration to supply essential continual administration and inhabitants well being knowledge.
Survivorship: An emergence of digital-hybrid communities and diet assist to assist with a affected person’s altering life-style
Sufferers will need extra individualized assist as remedy and affected person administration turn out to be extra focused and personalised. In at the moment’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 reminiscent of Encourage and That is Residing With Most cancers have emerged to supply neighborhood assist and steering on remedy choices in newer years.
Along with peer assist networks, expert-guided digital clinics, reminiscent of VivorCare, have emerged to supply custom-made assist and tailor-made packages that assist most cancers survivors handle their care outdoors 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 Diet, Season Well being) which are properly positioned to fill the hole for oncology sufferers with food-as-medicine, much like how these gamers are managing sufferers with continual ailments reminiscent of diabetes.
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 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 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 subjects associated to oncology, innovation and tech-enabled companies for most cancers care supply. This text wouldn’t be attainable with out their assist.
#Contributed #digital #well being #enhance #most cancers #care #supply
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