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The Pandemic’s Effect on Screenings

A conversation with Kevin Fosnocht, M.D., Former VP, Clinical Network and Strategy at Thyme Care and current Chief Medical Officer at Tandigm Health, and Cindy Revol, SVP, Oncology Solutions, Trilliant Health

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Cindy Revol: Hi, Cindy Revol here, SVP of Oncology Solutions with Trilliant Health. I'm here in Nashville with Dr. Kevin Fosnocht of Thyme Care, VP of Clinical Network and Strategy. 

Dr. Fosnocht, do you mind giving us a quick overview of what Thyme Care does? 

Kevin Fosnocht, M.D.: Sure. Thanks, Cindy. It's really good to be here. Thyme Care is an oncology care management platform that brings a tech-enabled virtual care management team to patients who were recently diagnosed with cancer and stays with them through their cancer journey. 

Cindy Revol: Great. That sounds really important in light of the different care pathways and navigation that can happen in an oncology setting. One thing we've been talking about a lot at THE Summit is the impact of the pandemic on patient behavior and how that's affecting care across disease states. Can you shed any light on how the pandemic has affected the oncology landscape in terms of patients getting screened, diagnosed, and their ultimate treatment, and how patient-physician behaviors may have changed? 

Kevin Fosnocht, M.D.:  It's been well documented, especially in the first year of the pandemic, the reduction in cancer screenings. An early estimate was that just for colorectal and breast cancer, the reduction in screenings could translate to 10,000 excess lives over time of mortalities. This was seen very early on. There have been several studies that showed mostly a rebound of screening, but most cancer is actually not diagnosed by screening; to the extent that is one measure of how patients avoided their care, patients avoiding seeking care with symptoms that were signals of development of something worrisome, we have not yet seen really what the full impact is on cancer care being interrupted and the impact it has on mortality. 

Cindy Revol: You mentioned that screenings are just one way of diagnosing cancer, but a lot of times, maybe a primary care physician or a specialist that a patient has seen more regularly, you talk about your platform being care management; how do you think about the role of these non-oncology providers in your platform and in your network and that overall care coordination? 

Kevin Fosnocht, M.D.: Really very important. Most cancer is diagnosed in a primary care setting. For the most part, people end up with an oncologist as a result of primary care referral or another provider referral. This is especially true for older populations. Not just from the standpoint of care coordination, but for us to be able to engage patients early on in their cancer care, we need to be connected to primary care physicians. 

The second component is that many patients don't just have cancer as their illness; they have multiple other illnesses. Those need to be managed and co-managed throughout a patient's cancer journey. So that requires the coordination of care with the PCP. The diagnostic component of cancer care can involve multiple providers, as you said, so understanding who those providers are and then our ability to coordinate their care on behalf of the patient is really what we're trying to do. 

Cindy Revol: Perfect. So, in order to do that, you have to work closely with payers and providers to use your platform. Controlling those costs is a big focus, particularly in oncology, where we're seeing those costs increase quite dramatically, partly due to population growth and need but also due to wonderful innovation and drug development and therapies, but they end up costing more. So, what is your strategy for helping to control those costs while still ensuring that the patients are getting the therapies and the treatments they need? 

Kevin Fosnocht, M.D.: This is critical, and I think fundamental to a value-based care approach to cancer care. There is still an opportunity for some very basic elements of care costs that are avoidable. In our data, when we look at large datasets for our payer partners, we're able to identify what those opportunities are based on our assessment of what's an avoidable admission, ER visit, or observation stay. There is always opportunity. 

We're seeing evidence of cost reduction by avoiding acute care utilization with our intervention. In fact, just this month, we presented an abstract drawn from our first population with a regional Medicare Advantage plan and showed almost a $430 per member per month reduction in the cost of care. Most of that came from acute care utilization. 

Cindy Revol: Wow. When you say acute care utilization, is that mostly... 

Kevin Fosnocht, M.D.: Mostly hospitalizations. In terms of the relative scope of the contribution of those costs, it was mostly hospitalization. 

Cindy Revol: What is the strategy for avoiding those hospitalizations? 

Kevin Fosnocht, M.D.: We partner early and often with the patient and their families in whichever method they want to stay in contact with us. All of our patients are assigned an oncology care nurse and a lay navigator. We call them care partners, and that team then stays with the patient throughout their cancer journey. 

We focus on assessing and helping to overcome social determinants of health; many interventions center around securing transportation to visits, financial assistance to mitigate the financial toxicity associated with cancer, coordinating their care with other providers and communicating with their providers in a timely way in a language that is efficient for the providers, but also lets the patient and their caregivers have a route of communication to their providers that helps them understand their illness, then we can communicate their needs to them in an efficient way. 

Our platform also does a proactive symptom outreach for patients who are on chemotherapy, this intervention has been associated with mortality reduction in certain cancers, where a patient who is at a particular course of their treatment, we know, based on the treatment they're getting, and the timing of it, when they might have nausea, and things like dehydration or uncontrolled vomiting, not being able to eat. These things can land a patient in the ER, and we get in front of that by assessing how are you doing? Do you have your medicines? Do you understand what to do if it gets worse? Can we help you contact your provider if you need that in the moment? That's critical to our intervention, avoiding that kind of care. 

Cindy Revol: Are you using some sort of technology platform to interact with the patients? How does that play in? 

Kevin Fosnocht, M.D.: It does play in, yeah, we have our purpose-built oncology care navigation platform that we call Thyme Box. Our care team works in that. It's through that that our patients then interact with us. We can text, email, do video calls, even make regular phone calls through this platform, which allows us to make sure that we have a record of everything that's transpiring, as well as ensuring that it's secure from the patient's perspective as we manage their care. 

Cindy Revol: Wonderful. Well, thank you so much for being here today. Congratulations on your recent publication and success. I look forward to seeing what Thyme Care continues to do in the future. 

Kevin Fosnocht, M.D.: Thanks a lot, Cindy. Thanks for having me. 

Cindy Revol: Absolutely.