Transcarent, a fast-rising digital health company, is launching an oncology care management service to help patients navigate the complex and costly disease.
It’s the latest strategic move from the one-year-old patient navigation company, which raised $200 million in January and has achieved unicorn status in record time. Transcarent is helmed by CEO Glen Tullman, who previously led Livongo into one of the largest digital health initial public offerings (IPO) in history before selling to Teladoc in a $18.5 billion deal.
Self-insured employers, which pay Transcarent through either a per-member-per-month subscription fee, a fee-for-service model or a full-risk approach, will have the cancer care management service available for their employee members. The service will include provider search and treatment planning, access to lower-cost medications, social and emotional guidance, virtual visits from doctors and more.
Cancer care is increasingly costly item for self-insured employers and patients. According to an estimate from the National Cancer Institute, the patient economic burden for cancer care was $21 billion in 2019 and made up of patient out-of-pocket costs totaling $16 billion and patient time costs approaching $5 billion. For employers, the cost of cancer care is up to 12% when of their total health care budget, while most expect this number to rise to 25% by 2025.
Snezana Mahon, Transcarent’s chief operating officer, spoke with Digital Health Business & Technology about the company’s foray into oncology care management. The interview has been edited for length and clarity.
Why is Transcarent getting into this space?
When you look at what’s happening with COVID over the last two years, there is a huge delay in cancer care. We’re going to start seeing a tsunami of cancer diagnoses. Employers are looking at that trend and saying, “How do I get in front of this? How do I get more employees access to screenings and the ability to check for symptoms?” They know they’re going to have to absorb that cost if they don’t do anything about it.
What we’re also seeing is cancer is getting more complex. It isn’t just one disease. It’s hundreds of different manifestations of diseases. There are various stages of cancer and treatments are becoming more advanced. Cancer treatment needs to get more personalized and targeted in terms of guidelines that you can follow. How can we deliver this personalized care in cancer with specialized centers of excellence? We’ve seen companies try to manage this with standard disease management programs, but doctors can’t keep up with the advancements in treatment and how to give more specialized targeted care.
Lastly, there are a disjointed number of point solutions. Payers haven’t been able to give patients comprehensive longitudinal cancer care. Instead, they have the pharmacy benefit manager controlling the cost of the drug, they’ve bought digital point solutions that need to be managed separately, they have been curating and getting access to separate centers of excellence programs solutions and then they're also offering behavioral and mental health support. Employers have offered all these things, but it’s disparate and disconnected. It’s not a good experience.
What are some potential pitfalls in rolling out this service?
Oncology is complicated. As I said before, it's not just one disease. There are no standard set of guidelines for everything like we typically see for other conditions. Our focus is going to be on connecting medical, pharmacy and self-reported patient data to create a comprehensive, targeted, personalized strategy. That’s the biggest pitfall because we as an industry are not there yet.
Have you talked with cancer patients in developing this program?
Yes, absolutely. Our focus early on is going to be with the five most common cancers that you typically see today – breast cancer, lung cancer, colon cancer, certain types of lymphomas and melanoma. We were hearing from our surgical oncology members about the disconnect these patients feel. Patients are going to Dr. Google to search for symptoms, then they’re sent somewhere else for nutritional support, and then offered a social worker and then their healthcare provider assigns them a case manager. They’re telling us, “None of these people know what’s going on with me. I'm having to repeat myself 15 times over.” What we want to do is surround the member across the board and help guide their unique cancer journey. Because not a single person is going to have the same journey.
The average age of a cancer patient is over 65. Do you plan to work with Medicare plans?
Absolutely. The incidence rate goes up over 60, but we’re starting to see that rise quite a bit in [younger] populations. One of the reasons why is obesity. The obesity problem in the U.S. is vast and is becoming one of the biggest risk factors for cancer. We as an organization want to be able to support all lines of business, whether it’s government or commercial payers. We want to be able to get it right though. The first year or two, we're going to hone in all of these services and this experience and then we can truly serve the government populations really well.
