Lessons from Robin Shah, CEO and Co-Founder of Thyme Care, on guiding patients through their cancer journey and unifying the oncology ecosystem
Robin Shah, CEO and Co-founder of Thyme Care, an organization that collaborates across the cancer care community to improve access, experience, and outcomes, while lowering total costs.
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Welcome back to the Pear Healthcare Playbook! Every week, we’ll be getting to know trailblazing healthcare leaders and dive into building a digital health business from 0 to 1.
Today we're thrilled to get to know Robin Shah! Robin is the founder and CEO of Thyme Care, a groundbreaking oncology management platform. Thyme Care is a value-based cancer care enabler, collaborating with payers and providers to transform the experience and outcomes for individuals with cancer. Thyme Care's approach combines human guidance with data and analytics to guide patients through their cancer journey. The company partners with health plans and risk-bearing providers to assume accountability for enhanced care quality, improved health outcomes, and reduced total cost of care.
Robin's journey in transforming cancer care began at Flatiron Health, a leading healthcare technology company led by two remarkable founders Nat Turner and Zach Weinberg. There, he served as Vice President of Provider Marketing and Strategy, focusing on developing successful go-to-market strategies for both patients and healthcare providers. His passion for building a stronger future for community oncology led him to OneOncology, where he played a crucial role as a founding member. At OneOncology, Robin served as the Chief Development and Marketing Officer, overseeing provider development, marketing strategy, technology integration, and analytics, setting the stage for his work at Thyme Care.
In this episode, we discuss Robin's journey into the field of oncology, the inception of Thyme Care, the significance of care navigation in cancer, Thyme Care's strategic approach and achievements, as well as valuable advice for entrepreneurs, including guidance on choosing the right investment partners.
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How Robin Stepped into Oncology
Robin's journey into the world of oncology was a natural evolution, deeply rooted in his family's commitment to healthcare. His father, a highly experienced medical oncologist in south-central Pennsylvania, provided the initial inspiration with nearly four decades of dedicated service in the field.
Robin's younger brother continued this family legacy by becoming a community oncologist in Philadelphia, while his older brother initially pursued a career in the Navy as a nuclear submarine engineer, completing multiple tours of duty. He currently contributes to OneOncology and remains an active reserve member.
It's a source of pride for Robin's father to have all three sons making a significant impact in the oncology space.
As Robin grew up around his father's oncology practice, he gained profound insights into the challenges cancer patients faced. With his extensive work experience at Flatiron Health and OneOncology, he became a trusted navigator for individuals across the nation grappling with cancer diagnoses.
"I would receive phone calls from people all across the country, even to this day, saying, 'Hey, Robin, either I, my friend, colleague, or family member has received a cancer diagnosis, and I don't know what steps to take.' In response, I naturally transitioned into a navigator role. Subsequently, I reached out to several of my former colleagues from Flatiron, expressing the need to address this issue."
Lessons Learned from Flatiron and OneOncology
Robin's tenure at Flatiron Health, under the leadership of Nat Turner and Zach Weinberg, offered profound lessons in the art of recruiting exceptional talent and building high-performing teams. These teams bring a rich tapestry of skills, from technical expertise to marketing, sales, and finance, all vital for effective company development.
Such diverse and exceptional teams not only cultivate innovation, creativity, and efficiency but also shape the bedrock of a strong company culture.
The insights gained from Nat and Zach's leadership at Flatiron Health laid the groundwork for Robin's subsequent venture, Thyme Care.
A striking example is Manya Ellenberg, a former Flatiron employee now driving Thyme Care's People department, instilling a culture of continual improvement.
Robin's experience at OneOncology underscored the paramount importance of securing substantial early-stage capital and the agility to rapidly scale an organization.
Early-stage companies rely on significant capital to fuel operations, product development, marketing, and infrastructure while providing a buffer against market uncertainties.
Swift and effective scaling is indispensable in the dynamic healthcare landscape, fostering customer acquisition and strategic partnerships.
These invaluable insights were instrumental at Thyme Care, where they adeptly managed capital and achieved remarkable growth.
Today, Thyme Care boasts a team of approximately 160 individuals, credited to the lessons derived from Robin's tenure at Flatiron and OneOncology.
How Thyme Care was Started
In late 2019, Robin got in touch with his close friend Brenton Fagnoli to discuss an innovative concept he had in mind – patient navigation. The inspiration for this idea stemmed from a personal experience involving a friend's mother who had received unsettling news about a potential case of pancreatic cancer.
The most unsettling part of her story was the agonizing waiting period. Despite the concerning diagnosis, she had to endure a daunting four-week wait for the earliest opportunity to undergo a confirmatory PET scan, a crucial imaging test for diagnosing conditions like pancreatic cancer.
“So I actually called my dad and told him what was going on with my friend’s mother.
“My dad ordered a PET scan for her on a Wednesday, and she had the scan the very next day, on Thursday. Then my father saw her on Friday, and was able to get her started on treatment by Monday.”
Despite her late-stage pancreatic cancer diagnosis, she remarkably survived for several years – a feat defying the abysmal 3% survival rate associated with such cases. This life-saving outcome was made possible by expeditious diagnosis and treatment initiation, thanks to Robin and his family's intervention by acting as patient navigators.
Robin subsequently reached out to Brenton, and they convened in New York at a WeWork space to brainstorm and reach out to individuals about a potential innovative patient navigation solution.
Robin has extended his support in patient navigation to a wide spectrum of individuals, ranging from health plan executives to even hospital administrators who, while familiar with the stories and journeys of cancer diagnosis, have never personally experienced it. The moment they or a family member do go through it, they quickly grasp the challenges involved.
Throughout a cancer journey, Robin highlighted several critical aspects that emerge:
Feeling of Uncertainty: When you or someone close is confronted with a potential cancer diagnosis, your accumulated knowledge seems to evaporate. Vulnerability and fear take over, leaving you in a state of uncertainty.
Diagnostic Dilemma: When a patient is anxious about a potential cancer diagnosis, the last thing they need is a protracted confirmation process. It shouldn’t take weeks to order labs. It shouldn't take weeks to initiate lab tests and analyze critical data, such as blood smears or pathology slides. This recurrent issue affects many patients, highlighting the urgent need for a more efficient process.
The need for a Comprehensive Care Model: For cancer and any other chronic condition, numerous healthcare needs arise outside the clinical setting. Unfortunately, the existing system often falls short in providing adequate support.
Based on these critical aspects, Robin focused on creating Thyme Care that was tailored to offer comprehensive whole-body care around the clock. Thyme Care not only helps patients get the diagnosis faster but also caters to edge cases, such as a patient feeling unwell on a Friday afternoon with no access to their doctor.
Instead of rushing to the hospital and spending a weekend there, Thyme Care provides guidance to avoid the unneeded hospitalization.
These are the kinds of cases where Thyme Care can add tremendous value for individuals facing a cancer diagnosis and undergoing treatment by delivering high-value service recommendations that truly meet a patient's needs.
The Thyme Care approach has three key parts:
An interdisciplinary virtual care team of nurses and care partners (clinical and non-clinical) who engage early and often to help each individual navigate the system, creating an experience that feels personal, modern, and empowering
An oncology care management platform and data-driven insights including health analytics and predictive capabilities for early intervention
A deep provider integration where Thyme Care identifies and partners with high-value oncology groups and PCPs within a plan’s existing network operating as an extension of their clinical team, aligning incentives and driving a more coordinated experience.
Through partnerships with oncology practices, Thyme Care ensures priority access to appointments for Thyme Care members and also facilitates integrated EHR-based longitudinal data tracking.
It enables real-time decision support to reduce drug costs and collaborates with partner PCPs via Rapid Access Pathways to enhance member care coordination and reduce fragmentation, ensuring a seamless PCP-to-member relationship.
How patients enroll into Thyme Care
Thyme Care partners with providers and health plans to provide personalized, clinically coordinated care to individuals with cancer
The primary aim is to facilitate patient enrollment into Thyme Care at the earliest possible stage, ideally during the peri-diagnostic period (the time between a positive finding on a screening test and leading up to a formal diagnosis and treatment).
However, in cases where patients are not identified during this peri-diagnostic period due to various reasons, Thyme Care remains committed to locating and informing these individuals about our services.
Multiple strategies for outreach are employed, including direct communication through primary care physicians and oncologists, as well as engagement with their health plan partners who may use mass marketing campaigns to reach their members, who can then connect with Thyme Care.
Furthermore, thanks to extensive collaboration with healthcare providers across different regions, Thyme Care has the capability to make contact with potential enrollees in tandem with or on behalf of their healthcare providers. This collaborative effort enhances the ability to engage individuals in the Thyme Care program effectively.
Importance of Cancer Care Navigation
The first patient navigation program in America, initiated by Dr. Harold Freeman in 1990 in Harlem, New York, was designed as a strategy to improve health outcomes in marginalized communities. Dr. Freeman's pioneering efforts in patient navigation from decades ago still carry a sense of urgency and importance today.
Cancer Care Navigation can mean many things including helping establish the first appointment with an oncologist, providing emotional support, ensuring goal-concordant care — and everything in between.
There is significant literature that highlights the benefits and results of patient navigation across the cancer continuum
“My co-founder and chief medical officer, Dr. Bobby Green always tells me if navigation was a drug, it'd be available in every single market because of how effective it is.”
While the adoption of new drug therapies tends to happen rapidly in the United States, the same cannot be said for the field of cancer navigation. Implementing and scaling cancer navigation can be challenging due to the intricate interplay of people, processes, and technology.
When executed effectively, the synergy of technology and healthcare professionals with expertise in cancer care allows teams to precisely tailor care plans to an individual's specific needs.
At Thyme Care, this process begins with the analysis of data from health plan and provider partners, as well as real-time patient-reported data. This information is then integrated into their analytical platform to reveal both clinical and socio-economic insights.
Subsequently, Thyme Care efficiently identifies potential risks for individual patients, helping to avert adverse events. Their analytical tools provide valuable guidance to their Care Team, which comprises Oncology Nurses and dedicated lay health workers referred to as Care Partners.
Leveraging technology, Thyme Care can process and synthesize thousands of data points, enabling their Care Team to effectively navigate and support their members. This is achieved while ensuring that the clinical teams responsible for patient care receive the necessary information without overwhelming them with excessive data
How Thyme Care Aligns with CMMI’s New Enhancing Oncology Model (EOM)
Effective navigation can only be implemented and create lasting results if there is an effective reimbursement framework for it
The CMS Innovation Center announced in July 2023 the Enhancing Oncology Model (EOM), a value-based payment model for medical oncologists intended to lower the total cost of care for patients with cancer while improving the quality of the care received.
This voluntary, 5-year program represents an evolution of the earlier Oncology Care Model, or OCM, which had 126 participating practices by the end, but which in the aggregate failed to save money for CMS.
One significant aspect of the Enhancing Oncology Model is its requirement for practices to have a navigation program. It also mandates that practices or healthcare organizations take on downside risks, a requirement absent in previous models. These two requirements align well with Thyme Care's core capabilities.
Thyme Care's role within this program involves providing navigation services, analytics, and reporting.
Given the associated financial risks for participating organizations, Thyme Care also has dedicated teams in actuarial science, health economics, and data science to support the program. These are specialized resources that most practices do not have in-house, making Thyme Care a valuable partner for organizations participating in the EOM program.
It's important to note that individuals diagnosed with cancer do not incur any out-of-pocket expenses with Thyme Care.
The model is primarily focused on health plans, and Thyme Care partners with risk-bearing entities such as commercial health plans, Medicare Advantage plans, and risk-based primary care groups.
They do not charge a fee-for-service; instead, Thyme Care establishes risk-based agreements with these entities, where they share in the downside risk of the cancer population while applying their navigation services, similar to CMS's approach in the Enhancing Oncology Model.
Thyme Care’s Strategy
Thyme Care collaborates with health plans, employers and risk-bearing providers to assume accountability for enhanced care quality, improved health outcomes, and reduced total cost of care
Leveraging the team's extensive prior experience in the oncology field at Flatiron, One Oncology, and other sectors, valuable relationships have been established with numerous providers and practitioners.
The value proposition for oncology practices is straightforward: navigation services are offered at no cost to the practices or their patients. Importantly, the navigational support provided by Thyme Care also benefits the providers by ensuring they are well-informed and actively engaged in the patient's cancer journey.
Engaging with health plans is a process, as they are the financial sponsors of the services. However, momentum has been steadily building as individuals who have experienced Thyme Care's navigation firsthand realize its profound impact.
“We often hear from someone from the health plan side that they are going through a cancer experience, and then either I or my co-founder, Bobby, step in to provide navigation for them or their family members. This firsthand experience helps them truly grasp the significance of navigation, contributing to the momentum we're building.”
In 2021, Thyme Care created a strategic collaboration with Clover Health , a Preferred Provider Organization (PPO) and a Health Maintenance Organization (HMO) with a Medicare contract. The partnership builds on the companies’ shared vision to improve lives and eliminate health disparities by delivering personalized support and resources at no cost to Clover’s Medicare Advantage members across New Jersey.
Thyme Care commenced its journey in October 2020 and saw its first patient in March 2021. Currently, Thyme Care operates in 21 markets, effectively managing 500,000 lives with 1-2% of the population undergoing active treatment at any given time.
Patients receive Thyme Care's support from the peri-diagnostic period to survivorship. The attribution and financial methodology with health plans specify the period during which a member falls within their attribution or risk pool. However, patients can access Thyme Care independently of this pool, and the services provided during the peri-diagnostic, survivorship, or admission periods come at no cost to them. In this manner, Thyme Care is dedicated to providing holistic care to all its members.
Outcomes due to Thyme Care
At the 2023 ASCO Quality Care Symposium, Thyme Care unveiled groundbreaking research, shedding light on the substantial cost savings facilitated by its holistic cancer care navigation and support services.
In a retrospective study involving patients undergoing cancer treatment, participation in Thyme Care's virtual cancer care navigation program translated into an impressive $600 reduction in total monthly costs for navigated patients, as compared to a control group.
Notably, the lion's share of these savings, amounting to $421, was attributed to a significant reduction in inpatient hospitalization-related expenses. Furthermore, the navigated cohort exhibited statistically significant reductions in laboratory expenditure (a $40 decrease) and radiation treatment costs (a $110 reduction).
Within the healthcare domain, particularly in the context of oncology, it is often overlooked that managing a chronic condition entails far more than merely addressing the immediate ailment at hand. It encompasses a myriad of facets of an individual's life, including comorbidities, which frequently take a back seat when a patient is grappling with a cancer diagnosis.
Additionally, a host of non-clinical variables come into play. Cancer patients may find themselves undergoing treatment multiple times a week, making frequent doctor visits, and grappling with financial, transportation, psychosocial, and behavioral challenges. Sadly, these critical aspects are often relegated to the shadows.
In a strategic collaboration with a prominent Medicare Advantage health plan, Thyme Care introduced a scalable, independent virtual care navigation program meticulously crafted to curtail the overall cost of care for the health plan's cancer-stricken population. Enrolled members engaged with the dedicated Thyme Care Care Team, comprising experienced oncology nurses and adept lay navigators.
Empowered by Thyme Care's purpose-built care management platform, known as Thyme Box, the Care Team adeptly addressed a spectrum of clinical and non-clinical concerns plaguing the members.
Symptom management: Proactive and reactive engagement with Thyme Care's oncology-trained Care Team empowered navigated members to tackle cancer and chemo-related side effects outside the confines of the clinic, significantly mitigating the need for unnecessary hospitalizations.
Coordinated care: Helping members navigate the labyrinthine healthcare system, facilitating timely access to oncologists, streamlining appointment scheduling, and orchestrating seamless care coordination between specialists, navigated members experienced enhanced care coordination that effectively dismantled potential gaps or barriers to their care.
Access to social services: Navigated members were thoughtfully connected to an array of resources catering to the social determinants of health, encompassing financial assistance (49%), assistance with food insecurity (28%), and improved access to transportation (20%). The initiative also encompassed education and support services tailored to managing side effects (49%) and navigating the intricacies of treatment and diagnosis (25%).
An example of a real patient scenario illustrates Thyme Care’s impact on patient well-being.
A cancer patient was undergoing treatment who had been grappling with persistent pain in their left leg. This patient, proactive about their health, received a text message from Thyme Care one day, requesting them to report their pain level. On this particular day, the patient responded with a higher pain score than usual, setting off a risk alert within Thyme Care's system.
In response, an oncology nurse quickly reached out to the patient to understand their symptoms and documented the details. Recognizing the urgency, the nurse then contacted the patient's oncologist, who reviewed the provided information. Based on the patient's symptoms and the nurse's notes, the oncologist made a critical decision – an immediate x-ray was needed to assess the leg.
Thyme Care swung into action, coordinating the patient's transportation and scheduling the x-ray within just 24 hours. However, upon arrival at the imaging center, a significant issue came to light – there was no existing order for the x-ray. In many cases, this could have led to the patient being sent back home, causing delays in diagnosis and potentially severe complications.
Fortunately, Thyme Care had access to the patient's electronic health record (EHR), allowing them to identify and address the problem swiftly. Rather than sending the patient home, Thyme Care promptly transmitted the necessary order directly to the radiologist. This timely response was critical, as the x-ray revealed a startling fact – the patient was mere hours away from a potentially catastrophic leg injury.
Thanks to Thyme Care's quick intervention, the patient was immediately directed to the emergency room (ER). Thyme Care continued to support the patient, coordinating their transportation and ensuring they received the necessary care, even after their discharge from the hospital.
This real-life example vividly illustrates how Thyme Care's vigilance, technology, and coordination can significantly impact a patient's journey.
Looking to the beginning of 2024, there is excitement about the expansion of services. This summer, Thyme Care launched its virtual clinic and began hiring clinicians to enhance remote offerings.
These clinicians specialize in providing immediate or after-hours care, ensuring patients receive timely and appropriate support. There is a continual exploration of new ways to enhance the patient experience and enthusiasm about the positive impact that can be made on cancer patients by making these services readily accessible and available to them.
Choosing Investment Partners Wisely
"Your investment partners, they're like your everyday teammates. Trust goes both ways—you've got to trust them, and they've got to trust you. It's all about building a solid relationship, and they need to be all in on your mission."
Before their series B, most of Thyme Care’s investors had already been part of Robin’s journey in previous ventures, like Flatiron and OneOncology.
They had a history together, and that mutual trust allowed investors to challenge them in ways that proved invaluable. They weren't just investors; they became an integral extension of the team. They carried this ethos forward to their series B, where they raised 60 million led by Town Hall Ventures and Foresite Capital.
Despite the relatively short period of collaboration with these new investors, Robin and the team have quickly forged a strong partnership that feels like years in the making. It's a testament to the immense value in selecting investors who align with your mission and are willing to collaborate in building a successful business.
"Our newest investors have only been in our boardrooms and cap tables for a couple of months, but it already feels like we've worked with them for years, even though no one on our management team had experience working with these investors before. Our new investors also mesh well with our current investors, allowing us to operate effectively."
When it came to deciding how much capital to raise, Thyme Care always planned for an 18-24 month runway, carefully considering factors like risks, opportunities, hiring needs, product development, and partnership building. Thyme Care believed that with the right team, it could manage effectively within those parameters.
The next phase of Thyme Care's investment journey focused on acquiring multiple customers and execution. Thyme Care made educated estimates, and it turned out they were incredibly accurate—both during their seed funding and series.
"In our most recent fundraising round, we constructed a comprehensive five-year financial forecast and plan, which we've been steadily following since its creation in late 2022 or 2023. This approach has prepared us for a strong focus on growth, as we now manage our budget and conduct quarterly meetings with a level of rigor akin to larger, publicly traded companies—qualities that Series B or growth investors highly value. This sets the stage for our future endeavors, whether it's another fundraiser or a new opportunity.”
Advice for Entrepreneurs to Build High Value Companies
Involve Loved Ones: Building anything substantial comes with its fair share of challenges. Robin found it helpful to involve family members in the journey. While Robin's spouse and three-year-old child weren't directly involved in healthcare, Robin engaged them in conversations about the work. Sharing experiences with loved ones can remarkably alleviate stress and create stronger bonds with those you spend the most time with. This, in turn, fosters empathy and understanding at home, which can be invaluable in navigating challenges.
Stay True to Core Values: When things get tough, Robin suggests knowing and sticking to your core values and worldview. Stay committed to these principles, especially when building something of great significance. Avoid rushing into decisions to ease immediate pain; sometimes enduring temporary difficulties can lead to better long-term solutions. For example, during Robin's Series D fundraising, they chose a lower valuation to prioritize the people they wanted at the table. This decision turned out to be one of the best ones made, highlighting the importance of valuing people over monetary valuation.
Passion and Personal Connection: As organizations grow, Robin emphasizes the importance of having a team with a deep passion for and personal connection to the mission. This is particularly crucial for mission-driven organizations. Robin found that having a team genuinely committed to the cause helps in navigating tough times together and facilitates more open and productive conversations. When everyone is aligned in the same direction, pursuing the collective goal of making a difference in a complex landscape becomes more manageable.
Interested in Thyme Care? Learn more on their website, Twitter, and LinkedIn
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