Partnering with Providers to Improve the Cancer Care Experience - Dr. Brad Diephuis, Chief Business Officer of Thyme Care

Michael Carrese: Hi, everybody. I'm Michael Carrese welcoming you to Raise the Line with Osmosis from Elsevier, an ongoing exploration about how to improve health and healthcare. For the two million Americans diagnosed with cancer each year, the emotional toll of absorbing the news is often exacerbated by uncertainty about the variety of treatments and confusion trying to navigate a fragmented healthcare system.

Well, that's where Thyme Care enters the picture, a company that provides dedicated support for cancer patients. From connecting them to faster access to care, helping them understand their diagnosis and treatment plan, and connecting them to community resources, Thyme Care offers comprehensive support for the entire patient journey. 

I'm joined today by Dr. Brad Diephuis, Thyme Care's Chief Business Officer, to learn more about how the company is working to improve the cancer care experience. Thank you so much for joining us today. 

Dr. Brad Diephuis: Thanks so much for having me.

Michael: We always like to start by having our guests tell us what drew them to medicine, and in your case, you then specialized in primary care. So, how'd you end up doing that? 

Dr. Diephuis: Yeah, I took a little bit of a later route into medicine relative to many of my med school classmates. I actually studied electrical engineering and computer science as an undergrad and had taken no pre-medical courses, and as will become quite relevant as we talk about Thyme Care, my entry into medicine actually started from my journey as a patient. 

When I was in my early twenties, I was diagnosed with an osteosarcoma, a rare form of bone cancer, and spent the better part of two years in and out of the hospital receiving both chemotherapy and surgery for that. I consider myself very fortunate that I received great medical care and fortunately, that's all in the rearview mirror, but at the time, it exposed for me both that healthcare is incredibly important and American healthcare has a lot of room for improvement. 

I took this somewhat later career path. I took some night classes -- post-bacs for any of the fellow MDs who went through that process -- and entered into medicine, and always sort of saw myself as a generalist in medicine. I liked thinking about the whole patient and all of the different components that go into thinking about whole person care. That's what drove me to primary care. I also think primary care is a great place to think about systems of care and how to deploy better wraparound systems of care for patients. All of that drew me both into medicine initially, and then into the primary care space. 

Michael: But you didn't want to specialize in oncology.

Dr. Diephuis: Yeah, it's a very fair question. If you asked me on day one of starting medical school, I was going to go into oncology. As I went through medical training, as I mentioned,

I became increasingly inclined towards focusing on the systems aspects of healthcare and how do we think about the whole patient and how do we think about the incentive models and that ultimately led me into the direction of working on policy for a bit, which we can talk about later. But I felt like the medical oncologists that I really admired had this deep understanding of the biology of cancer and many of them had spent a lot of time in the laboratory setting and that just wasn't who I was as a medical student. I think if I had an infinite number of years, I probably would have done a fellowship in oncology, but my wife told me I had to get a real job at some point. So, I decided not to jump into the fellowship. 

Michael: (laughs)We all need somebody in our lives to make us be realistic, right? 

Dr. Diephuis: Exactly. 

Michael: So, you noted the policy experience. Tell me about that.

Dr. Diephuis: Yeah, I had a fantastic opportunity after finishing my residency. I took a somewhat divided course through residency where I started residency, left to work on a startup and then returned to residency a few years later, but when I finally finished my residency, I had the opportunity to join the Center for Medicare and Medicaid Innovation, known as CMMI. It was actually established under Obamacare, the Affordable Care Act, and has done a number of different demonstration projects that I suspect many listeners here are familiar with through CMMI and had the opportunity to join with them in 2021 with the new administration under the Biden administration. I highly recommend to anybody who is interested in health policy, or even just what are the incentive systems that drive a lot of what we do here in medicine, to think about opportunities to work either at the state level or the local level or at the federal level.

I already knew healthcare was complicated, but I came away from it having so much respect for the folks at Medicare. The level of complexity and the level of different decision-making that they're trying to do on a week-to-week and month-to-month basis is incredibly high. I am a big supporter of CMMI's ongoing programs and I think over the past ten years, they've made tremendous progress on a number of models that have directly showed savings and directly showed an improved quality for patients, but I think perhaps even more importantly, catalyzed a lot of industry change in terms of rethinking how we care for patients and how we think critically about what are the cost drivers of healthcare. 

Michael: Based on not starting in medicine and this policy journey you took -- and now being with Thyme Care -- you're clearly somebody who thinks much more broadly than just about medicine, which I imagine is very helpful in your current role. So, let's talk about that a little bit, and I guess probably back up and ask about the Thyme Care story, which is spelled T-H-Y-M-E. Tell us why the spelling, and how did this all come about? 

Dr. Diephuis: So Thyme Care, is named after thyme, the spice. I like to joke that there's no names left in healthcare and so you have to choose an inanimate object and add either care, health, or well to the end of it...and there's been a little bit of a run on spices for anybody

who's followed the healthcare naming trends. But more seriously, thyme is a fragrant herb for many people that evokes feelings of warmth and kindness, and our mission at Thyme Care is to make sure that patients feel supported and cared for throughout their journey. We wanted a name that would help evoke that emotion in folks, so that's the story of the name Thyme Care. 

I'm not a co-founder of Thyme Care. I joined about two years into Thyme Care's founding. We are fortunate that our two co-founders, Robin Shaw and Bob Green, have between them decades of experience in the oncology ecosystem. Robin and Bobby, as well as many of our senior leadership team, came from a company called Flatiron Health, which was a leading cancer data company that sold to Roche in the mid 2010s and I think had a tremendous impact on the oncology ecosystem. So, I would say at a high level, we had a number of people who knew oncology very well, had worked in that space for a long time and felt that there were still some fundamental challenges that we needed to solve in terms of the model of care delivery for patients going through cancer care. Many of these observations that they had are the same things I experienced in my own cancer journey.  

What I experience now all the time, as I know Robin and Bobby did when they founded the company and I suspect many of the medical listeners on this podcast have heard about this as well, is getting that phone call from a friend or a family member saying that they personally, or a close friend, recently got a diagnosis or heard something that places them at elevated risk of cancer, and what are the next steps and where do I go to? You know, all of us are happy to do that on an individual basis, but when you think about that from a systems level, our system should work a little bit better than needing to know somebody who's a doctor to help figure out the next steps and sort of hold hands through both the initial diagnosis journey, as well as throughout the entire treatment.

At the highest level, what we're trying to accomplish with Thyme Care is to be that trusted navigator, that trusted friend who understands the healthcare system and can help navigate you through your entire cancer journey. So, the founding objective of Thyme Care is we wanted to solve that very personal problem. We've built a lot of care models and business models around that, but that is our ultimate North Star in terms of what we're trying to build here at Thyme Care.

Michael: So, as you know, a lot of cancer centers have patient navigators that they assign to their patients, and they're wonderful folks who help them with all this stuff, so help us understand maybe how you guys are supplementing that role and how you do it.

Dr. Diephuis: Yeah, it's a great question. There's a lot of variation out there -- from academic centers to community oncology practices and at different levels of scale -- in the programs that exist already, and we like to view ourselves as being complimentary and supportive of whatever resources already exist for patients. Unfortunately, the reality is that there are too often too little resources that are dedicated to this challenge.

To give you a sense of the types of resources that we deploy for every patient that becomes a part of our model is they are assigned to what's called a care pod. That care pod includes a nurse; what we call a care partner -- but think of it as a lay health navigator that can sort of be the front line to answer any questions that come up; and a complex case nurse, all overseen by a nurse practitioner and a medical oncologist. So, there's this full wraparound team that is supporting every single patient that becomes a part of our model.

Unfortunately, while I think a lot of systems have been forward-thinking about how can we deploy our own navigation programs, frankly, there's just often not the resourcing or the business model around how to support that in a longitudinal way. You'll see some systems and some practices with navigators, but they frequently are not able to do sort of the scale of interventions that we do.

So, to give you a sense of the types of things that we do is we do regular patient reported outcomes, and proactive symptom monitoring for patients throughout their cancer treatment. We'll know -- based on what we see on claims data and EHR data on patients -- when are they at highest risk relative to when they had their recent treatments and what are the symptoms to watch out for and make sure that we are proactively addressing those things. Those are the types of things that everybody, I think, in the oncology space knows that we should be doing, but it's often hard to actually operationalize at scale.

Michael: Oh, sure. That's a big burden on staff time, you know, to track it like that and then do the outreach. So, talk about it from a patient perspective. How do they get into your system and then what's it like to be interacting with your care pod and the other things that you offer? 

Dr. Diephuis. The journey with Thyme Care starts with enrolling in our program. People enroll in our program through a number of different mechanisms, the most common of which is that we just get on the phone and call members and tell them about the services that we offer for relationships with oncology practices in the areas that we operate. In those cases, we will actually reach out either in conjunction with or on behalf of the practice in order to make it clear that we are a part of their team that will help coordinate across their care and not just to be sort of another third party that may introduce confusion or complexity. So, we talk patients through what are the services that we offer. It's a fully optional model. It's also, importantly, entirely free to patients. There is no cost associated with it, and that's one of the things that we emphasize when we speak to patients. 

The way to think about how a patient then -- if they choose to enroll in our program -- interacts with us on an ongoing basis is we are that sort of friendly hand, that friendly support that they can reach out to at any time during their cancer journey when they have questions. They can pick up the phone at any time, get one of their care team members and we will work through with them on supplemental educational materials to make sure that they're actually understanding what is happening in their treatment, right?

All of us have had the experience at doctor's offices where you have that thirty-minute visit. You get a ton of different information. You're trying to jot down notes and then it's two days later and you think, “I really wish I had asked X, Y or Z.” We can help fill that gap and make sure patients really understand where they are in that treatment journey. Sometimes it's our team that does that education, sometimes it's actually us saying, oh, you know, there's actually a big gap in understanding here. We're actually going to reach out on your behalf to the oncologist and say this patient needs a follow up visit to discuss X, Y or Z, or they're having trouble with some part of their follow up.

All of these are things that I like to describe as like the blocking and tackling of healthcare and what we all wish we had. But, you know, we've all experienced trying to track the health care system ourselves. It's hard, and it's emotional when you're going through treatment. Having somebody that can help you through that journey is invaluable. 

Michael: I was actually reading a statistic recently that people forget, on average, fifty percent of what they hear from their physician in an appointment, and that's rather alarming. It can sort of help explain how things start to fall through the cracks. 

Dr. Diephuis: It’s probably even higher when you are in what can often be a highly charged and understandably emotional setting in cancer care therapy. We see this all the time, and that's the types of gaps that we're trying to plug. 

Michael: Yeah, exactly right. I mean, a cancer diagnosis gets your attention in a completely different way than other diagnoses.

So, what kind of results are you seeing? Is this playing out the way you all are hoping in terms of patient engagement and outcomes? What can you tell us about that side of things? 

Dr. Diephuis: Yeah, absolutely. So, we're both thrilled with the outcomes that we've had to date, and we've learned tons since we started working with our first patient in 2021. It's exciting. We're now in the thousands of patients that that we've worked with and we have really iterated and developed our care model over time. The results we've seen across the board have been fantastic, starting with member satisfaction, members who choose to enroll in our program. Both rate us very, very highly in terms of their satisfaction with the program. We do regular member surveys on a 10-point scale, and we average a 9.7 on those surveys and perhaps more tellingly, we have very, very few patients -- I believe the number is around 1% or actually less than 1% -- that voluntarily opt to disenroll from our program. Patients see a lot of value from it and once they once they join the program are eager to continue in it. 

The types of things that we've looked at beyond making sure that people are happy in our program and are experiencing great care is actually looking at, are we having the impact on outcomes and on costs that we expect from this type of intervention? That's where we've been really excited recently. Back in 2022, we presented data at ASCO, one of the leading clinical oncology conferences, showing significant savings in terms of total cost of care for patients who are enrolled in our program...over $400 per member per month. We actually refresh that analysis in this year, and I've actually seen that number grow up to $600 for the members that are actively enrolled in our program, seeing very significant cost savings. The majority of that cost savings is coming from avoidance of hospitalizations and other high-cost experiences like that.

That's kind of what you'd expect from this type of model that is proactively addressing problems. The types of things that happen all the time are somebody is having nausea and vomiting and is unable to keep fluids down after treatment and if that went on for another twenty-four hours, they likely would present to an emergency room, which very frequently leads to an admission. If one of our nurses picks up on that earlier and is able to sort of coordinate care and get them plugged in for a next morning infusion at the oncology practice to get a bag of IV fluids and maybe a new anti-emetic, that can prevent that admission. And we all know things go wrong once you end up in the hospital.

We love seeing that data, both from a cost saving perspective -- that's important to our business model, which we can come back to -- but importantly, also from a patient experience and outcomes perspective, right? When patients end up in the hospital, they end up with chemotherapy delays. It's a less good patient experience. Nobody wants to spend extra time in the hospital. So all these are things that, again, we're seeing that are both reducing costs, but also improving the patient experience. 

Michael: Yeah, that's quite remarkable. What else do you want us to understand about the business model?

Dr. Diephuis Yeah, so we talked about how this model is completely free of charge. We are a business, and we need to fund this in order to scale this and continue to bring this to more patients. So, the way our model works is that we partner with insurance plans or more broadly, anybody who is responsible for your medical bills. That can be insurance plans, self-insured employers  - who are responsible for all the costs of care for their employees -- and then increasingly in the value based care world, there are primary care practices and health systems that are taking on what we call total cost of care risk. They are effectively saying, I'm going to help manage this patient and I'm going to be accountable for that patient, so that entity becomes responsible for all of the costs incurred by patients through their medical claims. 

Our value proposition to any of those entities is to say we can provide this set of services that we believe will both make your members happier and lower the cost that you're experiencing.

The way we contract is we say -- whether or not it's an insurance plan or one of those at-risk provider groups or employers -- here is our fee for our services and we'll actually put our money where our mouth is. We'll actually measure the savings that we've generated and if we don't generate savings and access of those fees, we'll actually refund those fees to you. If we generate savings and access of our fees and an access of additional savings benchmarks that we set with our payers, we then share an additional savings.

And so think about it as just a way to align incentives. In many ways, this looks very similar to some of the shared savings type models. 

Michael: I was going to say it kind of seems to be parallel to the shared savings models that came out under accountable care. 

Dr. Diephuis: Exactly. You can think about all of our contracts to date as effectively setting up individual shared savings models with our counterparties. And the reason both we like that model and our counterparties like that model is that it aligns everybody's incentives. Once we go live with a customer, we are frequently measuring and every quarter we will sit down and say, here's what we're seeing from a patient experience perspective. Let's tell you how we are improving care for people. Let's also look at some of the key outcomes in terms of how we are doing at enrolling patients? What are we seeing in terms of reductions in acute care events and all the other cost drivers that we know, again, can both lower outcomes and increase costs? 

Michael: This might be getting too much in the weeds, but I'm curious about how you folks are able to operate in terms of your ability to think kind of independently of concerns about ‘is there a code for this or will we be reimbursed for this?’ It seems like you're in a space where if you decide this is something that's going to be good for the patient, you can go ahead and do it within that budget that you've got, and maybe in a way even further than the physician could. Or am I misunderstanding? 

Dr. Diephuis: No, I think that's exactly right. In many ways -- going back to your initial question of why don't systems already do this or why don't they do it the same way that Thyme Care does it -- the answer is that there's not a good reimbursement code for the types of activities that we're doing. One way to think about our business model is we're effectively bringing these shared savings arrangements to the cancer space. So even though there's not a reimbursement payment for the services that we're delivering directly, because we enter into these shared savings arrangements, when everything goes well, the patient does better, the insurance plan does better and we do better. It means that you can step away from the constraints of what are the different billable codes here and towards what's best for the patient, which, again, is the reason why we all got into this. 

Michael: Yeah, no, it's terrific. And it builds on, I think, what people were hoping would happen with accountable care. So, that's really interesting.

Dr. Diephuis: Exactly. 

Michael: So, fairly recently, Thyme Care announced a new round of funding. Can you talk a little bit about what that's going to allow you to do?

Dr. Diephuis: Yeah, we've been fortunate to bring in great new investment partners in Town Hall Ventures and Foresight Capital, who led our Series B earlier this year. There are a number of different uses for the capital that we've brought on board. I'd say first and foremost is that we're now at the stage where we've worked with, as I mentioned, thousands of patients and multiple different customers in a few states. By the start of next year, we'll be in over twenty states and have greatly expanded the number of different clients that we work with. So, that's probably the single largest usage of that capital is to bring us to a larger geographic scale and allow us to support more and more patients with this.

Another thing that we're driving forward with that additional capital that we haven't talked about as much, is we form deep partnerships with the actual oncologists and the actual oncology practices that are delivering care. Our perspective is that our model can be most effective when our care pod team is working in close conjunction with provider groups on the ground. We've always had these relationships in place, but we're now deepening those. We're actually getting to the point of sitting down with practices and saying, okay, we're doing these navigation services...can we also work with you to understand where can we optimize some of your spend on different drugs and make sure that we're not being wasteful with how you are managing different pharmacy supplies? Again, this is the type of thing that becomes enabled when you create these shared savings relationships where you can say, okay, if we generate savings, how do we make sure that that both comes back to Thyme Care as a company, but also goes back to the provider groups that we partner with.

So, that's another big focus as part of our post Series B activities and a few other things in the works that we'll be announcing in the coming months and years. We’re excited for ongoing growth.

Michael: As I listened to all of this, what comes to mind is a healthcare system that works the way we all hope it did, but doesn't ever quite seem to. 

Dr. Diephuis: Exactly. Maybe coming back full circle to where we started in many ways, when I experienced cancer care, I had both great care and there were a lot of gaps in care and it didn't exactly always happen in the way we've hoped. When I thought from a creative perspective on what are the problems I'm really excited about working on, it's how can we help build models where we're getting a little bit closer to that patient experience that we know everybody deserves and that's why I'm here and it's why Thyme Care exists. 

Michael: That's a great way to put it. So, as we wrap up, we always like to get some advice from our guests to our audience of learners -- essentially medical students, nursing students, and early career professionals -- about approaching their career. You've had very interesting career path yourself. Do you have any advice about taking risks, or what else would you want to impart to them? 

Dr. Diephuis: I won’t pretend to have the ‘be all end all’ advice. I think there are any number of different fantastic routes through medical school and through clinical training and not the least of which is practicing full time. I feel like that gets overlooked when we’re talking about all these new exciting systems innovations. The people that are really making a difference in patients’ lives are the people that are dedicated to 100% clinical practice. So, I always like to have that disclaimer. I don’t want to undervalue the importance of individual clinicians in improving care delivery. 

For myself, one piece of advice I like to give folks in training is to seek out diverse groups of mentors. When you’re in medical school, naturally the people you interact with and the people that are your teachers and your assigned mentors tend to be folks that are within the medical centers that you’re training in, and by definition in many ways those are folks that are in academic medical world. The academic world is great. It's driven a lot of great success and if that's the right path for you, that's fantastic. But you're not going to automatically get mentorship from people that have chosen different career paths because they're just not the people that the medical school is going to have in front of you - through no fault of its own. It's just sort of the natural way that that process works. So, I always encourage people to think about how can you make sure you broaden and diversify the set of folks that you think about as mentors and identify people that you think have an interesting career path, so let me understand how and where you got there.

Then the second piece of advice I give folks is that I think we're sort of ingrained in medicine to sort of plot out every route: I go to residency, then I go to fellowship, and then I'm going to go to the subspecialty program and then I'm going to start my tenure track here and then look at the next institution. I think, particularly when you go outside of the fairly tracked route of academic medicine, it's really hard to plan that many steps ahead and if you asked me at any point in my career to predict where I was going to be at three years, it would have been completely incorrect. So, be open to change, be willing to recognize that new opportunities will come up that aren't on your radar, opportunities that you thought were going to be great may not materialize, and be willing to sort of adapt a little bit to those circumstances as they come up. 

Michael: Well, that's great advice and a great note to end on. I want to thank you very

Much, Dr. Diephuis, for joining us today and filling us in on all the interesting work that you folks are doing at Thyme Care. 

Dr. Diephuis: Well, thank you so much for having me. It's been great to participate today. 

Michael: I'm Michael Carrese. Thanks for checking out today's show and remember to do your part to raise the line and strengthen the healthcare system. We're all in this together.