Dr Samyukta Mullangi: Cancer Care Navigation Platforms Can Reduce Operational, Financial Challenges of VBC Systems

Samyukta Mullangi, MD, MBA, oncology fellow at Memorial Sloan Kettering Cancer Center and incoming medical director at Thyme Care, discussed how the transition to value-based care can contribute to operational and financial risks among oncology practices, and the effectiveness of care navigation platforms in addressing these concerns.

Partnering with care navigation platforms such as Thyme Care can prove beneficial for oncology practices, particularly smaller or rural clinics, in addressing operational and financial risks associated with the shift from fee-for-service (FFS) to value-based care (VBC) systems, said Samyukta Mullangi, MD, MBA, oncology fellow at Memorial Sloan Kettering Cancer Center and incoming medical director at Thyme Care.


Can you speak on the operational and financial challenges that arise from shifting from FFS to VBC, and why it would be beneficial to partner with companies like Thyme Care to ameliorate these issues?

Practices are increasingly making the move from FFS to VBC and with good reason. There are a lot of tailwinds that are orienting them in this direction, almost all of which are related to the fact that health care spend is increasingly taking up a greater portion of every dollar spent in this economy.

With that being said, transitioning to VBC is a huge operational lift for practices. Even short of participating in fully capitated payments, taking on risk sharing agreements with insurers represents a complete paradigm shift. Part of the problem is that practices—and this is not unique to cancer, but it's certainly true in cancer—are not equipped with the right technology tools to pursue population health, nor do they have adequate staffing to address concerns that are unearthed through systematic surveys on the like.

So, let me elaborate on the tech piece first. Oncologists today, no matter the EMR [electronic medical record] that they use, could not tell you basic things like what is the size of their panel, how many patients are on active treatment, how many patients are past first-line therapy in the metastatic setting. No EMR is systematically calculating things like frailty scores or palliative performance scales that can inform the need for advanced care planning or palliative care consults, for example.

If patients are admitted or seen in the emergency room at a local hospital, oncologists are often only aware of this if they have a good but informal relationship with that hospital’s case manager or if the patient or family directly informs them. And that is the state of affairs today, it's very difficult to pursue population health without a bird's eye view of your population.

I think the staffing piece is equally important. So, effective VBC and population health requires that oncologists regularly check in on how their patients are doing from a symptom standpoint, especially if they're on active treatment. You've heard of electronic patient-reported outcomes (ePROs), that is becoming more and more the norm. For example, CMS' upcoming Enhancing Oncology Model requires that practices have a system in place to periodically and regularly collect ePROs from their patients.

It's also important to unearth social determinants of health because that plays a huge role in how patients are doing and how they're being able to stay on treatment. But addressing the issues that can arise through these periodic assessments sometimes requires additional staffing. And while larger clinics can and may be able to accommodate and just absorb these new responsibilities into their existing staffing structure, it is harder for smaller or rural clinics to do so. With these new requirements, I would say that can perpetuate health inequities.

Thyme Care attempts to solve for both. So, its tech platform allows for intelligent triaging of patient acuity. It has an ePROs platform that performs battery assessments of symptoms and obtains information about social determinants of health. And the way the care model is set up is that there are systematic assessments of patient functioning. All of this is supported by teams of navigators and nurses, and supervised by a medical director who are fully remote and who are centralized.

I would say that the combination of the tech and the staffing that Thyme Care is able to provide represent capabilities that are just too expensive or onerous for any one clinic to replicate on their own. And honestly, there's no need. When there are solutions like this in the marketplace, I think practices should partner rather than trying to reinvent the wheel.

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