Simplifying Care Navigation in Oncology: A Painless Path to Better Support

The more robust the care navigation system, the better chance health care institutions have of lowering treatment-related toxicities, improving patient outcomes, and reducing the total cost of care, which is the ultimate goal of value-based oncology partners such as Thyme Care.1

“Thyme care is an oncology value-based care partner delivering 24/7, virtual cancer care support. We contract with payers, typically at-risk payers, Medicare Advantage payers, at-risk PCP groups, and some commercial payers,” Lalan Wilfong, MD, a medical oncologist/hematologist at Texas Oncology, and senior vice president of Value Based Care at Thyme Care, explained in a presentation delivered during the inaugural MiBA Community Summit.1 “We set a benchmark price of what we believe cancer care should cost in this population, and then we guarantee savings back to the health plan.”

Why Are Value-Based Care Partners Needed?

Wilfong stated that Thyme provides clinical and non-clinical navigation using an oncology-trained care team at no cost to patients and collaborates with oncology practices to strengthen care coordination, reduce practice burden, and offer novel incentive programs to lower the total cost of care.

The origin of the organization is grounded in the increasing number of challenges stacked against patients facing a cancer diagnosis and the organizations that deliver their care. For example, only 12% of adults are certain they can navigate cancer care on their own, and more than 50% of patients and survivors have reported feeling isolated because of their diagnosis and treatment. Additionally, 38% of patients on active cancer therapy do not report symptoms for fear of burdening their physician and 42% are left facing catastrophic financial burden because of their care.

On an institutional level, Wilfong noted misalignments in end-of-life care, with an average cost of $74,000 in the last 6 months of care in addition to potentially avoidable visits to the emergency department in over half of patients with cancer (Figure).

What Can Be Done to Combat These Challenges?

It starts by asking the patient how they’re doing, Wilfong asserted, maintaining that patient reported–symptom monitoring vs usual care can create a jump in overall survival (OS) equivalent to the gains seen with systemic therapies like bispecific antibodies in lymphoma, chemoimmunotherapy in uterine cancer, and CDK4/6 inhibitors in breast cancer.

Wilfong cited two trials in particular––one published in the Journal of Clinical Oncology and the other in JAMA––that showed that symptom monitoring led to improvements in health-related quality of life, reductions in emergency room admissions, and increased OS vs usual care.2,3

“The published research, which has been repeated multiple times over the years, has shown us that by doing proactive outreach with patients, we can lower the total cost of care, and we can improve outcomes and improve [patient] survival,” Wilfong said.1

To put this into context, Wilfong said in adopting proactive navigation companies like Thyme can lower the cost per member per month by $3 to $400 per patient. If the cost savings isn’t enough, Wilfong asked the audience to consider the time savings that could be afforded with increased efficiency.

“It’s important to meet the patient where they are and give to patients the things that they need, but then not overdo it with patients who don’t really need anything,” Wilfong added in an interview with OncLive® following his presentation.

But what exactly does a proactive approach look like? For Wilfong, effective interventions include administering electronic patient-reported outcome surveys, which have been shown to reduce the relative risk of emergency department visits by 40%, providing clear transitions of care from the hospital to the clinic to reduce the likelihood of readmission, completing an advance care planning conversation among patients with advanced cancer, and addressing an unmet social need.

Who Is Going to Pay for Care Navigation?

Costs to consider when implementing care navigation models include staffing costs, the costs associated with building or buying an electronic patient-reported outcome platform, the establishment of an analytics infrastructure to understand efficacy and performance, and necessary leeway for IT issues.

Contrast that with payment options, which could include navigation billing, gratis work, or innovative payment models such as risk-based contracts that are driven by economic incentives. With respect to the former, Wilfong explained, “These are billable codes that your staff can build as they’re doing this work and help cover some of the cost of doing this navigation work. For principal care management, you can make about $82 for 30 minutes. For principal illness navigation, you can get $78 for 60 minutes’ worth of work, but these are only found in certain Medicare and certain Medicare Advantage plans. Most commercial payers don’t pay these care navigation codes.”

Could AI Help Me Get This System Off the Ground?

However, cost overhead is not the only thing to account for when considering implementing a system like this in practice, Wilfong acknowledged, and in the same breath, he pointed to artificial intelligence (AI) as a way to alleviate some of these concerns.

For example, Wilfong said that AI can be easily adapted to serve as a voice agent for incoming phone calls, summarize medical records for relevant information, and identify risk flags from medical records and phone conversations for better risk stratification. Ambient AI can be used to create care team notes or grade care team responses for empathy and quality to ensure alignment with optimal care.

“You can use the AI agent to answer that call and give the patient directions to the clinic, to tell them when their appointment is, tell them what time to show up, tell them whether they need to be fasting,” Wilfong said.

Disclosures: No disclosures were listed.

References

1. Wilfong L. Advancing quality care through precision toxicity management. Presented at: MiBA Community Summit; September 27-28, 2025; Scottsdale, Arizona.
2. Basch E, Deal AM, Kris MG, et al. Symptom monitoring with patient-reported outcomes during routine cancer treatment: a randomized controlled trial. J Clin Oncol. 2016;34(6):557-565. doi:10.1200/JCO.2015.63.0830
3. Basch E, Deal AM, Dueck AC, et al. Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment. JAMA. 2017;318(2):197-198. doi:10.1001/jama.2017.7156