CMS implemented Enhancing Oncology Model (ECM) it’s successor of Oncology Care Model (OCM) effective July 01, 2023. In this blog we will focus on  understanding the salient features of this model.

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The Enhancing Oncology Model (EOM) is a voluntary alternative payment model designed to transform care for cancer patients, reduce spending, and improve quality of care. It aims to improve care coordination, quality, and health outcomes for patients while also holding oncology practices accountable for total costs of care. The EOM is a successor to the Oncology Care Model (OCM) and is part of the Biden-Harris Administration’s Cancer Moonshot initiative.

This is a voluntary participation program for physician group practices (PGPs) that care for Medicare patients with seven common cancer types: breast cancer, lung cancer, small intestine/colorectal cancer, lymphoma, chronic leukemia, multiple myeloma, and prostate cancer. This Program was open for participation application from June 27, 2022 to September 30, 2022.

Under the EOM, PGPs will be paid a monthly fee for each patient they care for, as well as two additional payments:

  1. A payment for providing enhanced services, such as patient navigation and survivorship care planning.
  2. A payment for achieving certain quality metrics, such as reducing hospital readmissions and improving patient satisfaction scores.

The EOM is designed to incentivize PGPs to provide high-quality, coordinated care to cancer patients. The monthly fee will help to cover the costs of providing these services, and the additional payments will provide further incentive for PGPs to improve the quality of care they provide.

According to CMS The goals of EOM are to:

  1. Put the patient at the center of a care team that provides equitable, high-value, evidence-based care;
  2. Build on OCM lessons learned and continue the value-based journey in oncology, which is a historically high-cost area of Medicare spending;
  3. Increase engagement of patients, oncologists, and other payers (e.g., state Medicaid agencies, commercial payers) in value-based care and quality improvement; and,
  4. Observe improved care quality, health equity, and health outcomes as well as achieve savings over the course of the model test.

CMS also provided following design elements that EOM employs in order to achieve these goals,

  • Comprehensive, coordinated cancer care;
  • Continuous improvement driven by data;
  • Payment incentives including a Monthly Enhanced Oncology Services (MEOS) payment, and a performance-based payment (PBP) or a performance-based recoupment (PBR);
  • An aligned multi-payer structure; and
  • Focused efforts to identify and address health disparities.

Key features of the Enhancing Oncology Model (EOM)

Focus on quality: The EOM is designed to improve the quality of care for cancer patients. This is achieved through a number of mechanisms, including the use of quality metrics and the payment of bonuses for achieving those metrics.

Coordinated care: The EOM encourages PGPs to provide coordinated care to cancer patients. This is achieved through the use of a monthly fee that covers the costs of providing these services.

Data-driven: The EOM is data-driven. This means that PGPs are required to collect and analyze data to track the quality of care they provide and to identify areas for improvement.

Collaboration: The EOM requires collaboration between PGPs, payers, and patients. This means that everyone involved in the care process needs to work together to achieve common goals.

EOM was launched on July 1, 2023, for a five-year testing period. If we go by the success of its predecessor OCM, EOM is a promising new payment model that has the potential to further improve the quality of care for cancer patients while also reducing costs.

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