Enhancing Oncology Model: New CMS value-based payment model aims to improve health equity and patient-centered care

Just days before the sunset of the CMS Oncology Care Model, CMS announced its new Enhancing Oncology Model (EOM), the new value-based care oncology payment model. Rolled out as part of the Biden-Harris Administration’s Cancer Moonshot, the goal of EOM is to improve the experience of cancer patients, while advancing health equity and increasing access to care, as well as reducing Medicare spending. Clinic participation is voluntary. Oncology practices may choose to participate by applying for this 5-year test program before September 30, 2022. The program will commence on July 1, 2023.  

Patient-Centered Oncology Care

Clinics participating in EOM are expected to provide enhanced patient-centered care, including:

• 24/7 clinician availability with access to your patient records;
• Patient navigation services; 
• A detailed care plan;
• Screening for health-related social needs (HRSNs); 
• Focus on the patient’s overall cancer, including assessment of the patient’s care and experiences through electronic patient-reported outcomes (ePROS).¹

Though similar to the Oncology Care Model (OCM), this new model has distinct differences pertaining to required practice redesign activities, beneficiary populations, participation in downside risk, and payment methodologies. Only beneficiaries with specific cancer diagnoses and who are receiving systemic chemotherapy treatment (excluding exclusively hormonal therapies) are eligible for EOM, these include: breast cancer, lung cancer, lymphoma, multiple myeloma, small intestine/colorectal, prostate cancer, and chronic leukemia.

The EOM model also compliments CMS’ recent focus on care management and care planning.  Participants in EOM must provide the following:

1. Provide beneficiaries 24/7 access to an appropriate clinician with real-time access to the EOM participant’s medical records;
2. Provide patient navigation, as appropriate, to EOM beneficiaries;
3. Document a care plan for each EOM beneficiary that contains the 13 components of the Institute of Medicine (IOM) Care Management Plan, as applicable to the EOM beneficiary;
4. Treat beneficiaries with therapies in a manner consistent with nationally recognized clinical guidelines;
5. Identify EOM beneficiary health-related social needs using a health-related social needs screening (HRSN) tool;
6. Gradual implementation of electronic Patient Reported Outcomes (ePROs);
7. Utilize data for continuous quality improvement (CQI); and
8. Use Certified EHR Technology (CEHRT) as specified in 42 CFR § 414.1415(a).

Focus on Health Equity and ePROs

Notably, EOM contains two new redesign activities aimed at enhancing patient care: health equity and ePROs initiatives. A key component of the EOM model is the alignment with CMS’ health equity strategy, including a requirement that participants provide details as to how they will mitigate health disparities amongst their beneficiary populations. Clinics will also be required to report beneficiary sociodemographic data to CMS. Acknowledging that additional resources and time may be needed for low-income beneficiaries, EOM will provide practices with an increased payment for beneficiaries who are dually eligible for Medicare and Medicaid.

A second key focus of the redesign activities is the inclusion of ePROs. Encouraged by several studies and journal articles, CMS supports the use of ePROs in oncology care settings as they “can lead to better identification of patients’ needs, improved patient-provider communication, care management, patient satisfaction, and advances in cancer outcomes, such as decreased ED visits and increased survival from certain cancers.” CMS does not require the use of a specific ePROs tool, but the tool must be designed to capture: symptoms and/or toxicity, functioning, and behavioral health. The ePROs requirement also extends to evaluating health-related social needs (HRSNs), with practices assessing at least transportation, food insecurity, and housing instability.