The Centers for Medicare and Medicaid Services (CMS) recently announced the Enhancing Oncology Model (EOM), the next iteration of its value-based, oncology care model. EOM is a five year program, set to begin on July 1, 2023.
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CMS designed the EOM to test the process of improving healthcare providers’ ability to offer cancer care in a way that integrates the best possible patient outcomes. This program supports the Cancer Moonshot initiative and President Joe Biden’s Unity Agenda – to improve the experience of people surviving and living with cancer. EOM aligns with the Cancer Moonshot pillars and prioritizes professional support to patients, cancer survivors, and caregivers.
What Are the Key Components of EOM?
Like the Oncology Care Model (OCM), EOM allows oncology physician groups and payers, such as state Medicaid agencies and commercial payers, to participate in the program through multi-payer agreements. Under the EOM, physicians or oncology practices will be paid an extra monthly fee to offer coordinated care to their patients. That means these payments will be slightly higher for beneficiaries dually qualified for Medicaid and Medicare.
EOM will also measure the value of oncology patient care based on six-month sessions of care where the start of chemotherapy (or other targeted therapies) will be the starting point of the session. Participating physicians or practices will be eligible for retrospective performance-based payment (PBP). These cost savings bonuses and penalties will be calculated based on the quality of care provided and cost savings during the six-month sessions of care.
All EOM participants will be required to implement specific redesign activities, such as:
- Patient navigation
- 24/7 access to oncology care
- Evidence-based guidelines
- Care management plans
- Use of electronic patient-reported outcomes
Additionally, oncology practices will be required to use data for improvement, screen for health-related social needs, and use certified electronic health record (EHR) technology.
Note that EOM focuses on beneficiaries getting systemic oncology care (that is, not beneficiaries getting hormonal therapy only) for various cancer types. These types of cancer include chronic leukemia, breast cancer, prostate cancer, multiple myeloma, small intestine cancer, lymphoma, and lung cancer.
Care Transformation
You must have implemented the following redesign activities to assess if your practice’s quality strategy aligns with the EOM objectives:
- Provide beneficiaries 24/7 access to a qualified clinician with real-time access to their medical information
- Offer patient navigation
- Document a care plan with all the 13 key components of IMMP (Institute of Medicine Care Management Plan)
- Adhere to all nationally recognized clinical guidelines
- Use certified electronic health record tech
- Use data for quality improvement
- Screen for health-related social needs
- Gradually implement ePROs (electronic patient-reported outcomes)
While these enhancements are intended to make it easier for all EOM participants to implement a patient-centered approach to oncology care, there will be a one-year gap between the ending of OCM and the start of EOM. This gap year provides potential participants the opportunity to prepare for the Enhancing Oncology Model and reap significant clinical benefits for their patients and financial benefits for their practice.
Interested in learning more about how best to prepare for EOM? Visit “Stay informed about the Enhancing Oncology Model”.
References
2. https://www.cms.gov/newsroom/fact-sheets/enhancing-oncology-model