Take 2: CMS Launches Successor to the Oncology Care Model

The Centers for Medicare & Medicaid Services (CMS) tomorrow will launch its new, voluntary alternative payment model, replacing the Oncology Care Model (OCM) that ended in June 2022.

The Enhancing Oncology Model (EOM), which will run for 5 years, represents the second major project aimed at improving quality and access to cancer care while reducing spending through payment incentives and other value-based activities.

CMS announced that 67 group practices will be participating in this project, slated to run through June 2028. These participants will focus on seven cancer types: breast cancer, chronic leukemia, lung cancer, lymphoma, multiple myeloma, prostate cancer, and small intestine/colorectal cancer.

Like the OCM, the EOM will focus on coordinating patient care across clinicians as well as implementing services that help patients better understand and navigate their condition and treatment, including housing and transportation services as well as psychological support.

The EOM will go a step beyond its predecessor, introducing new elements that build on lessons learned from the OCM. The EOM, for instance, will incorporate electronic Patient-Reported Outcomes and require practices to build in frameworks that promote health equity.

"No one should have to battle cancer without access to high-quality, coordinated care," said HHS Secretary Xavier Becerra, in a statement last year. "With this new Innovation Center model for oncology care, we are delivering on President Biden's call to action to mobilize every option to address cancer, and creating a system of care that supports all patients and their families."

Will the Revamp Work?

Still, it remains to be seen whether the newly launched EOM can improve on the results of its predecessor, health policy expert Robert Kocher, MD, a partner at the venture capital firm Venrock, told Medscape.

Analyses exploring the effects of the OCM have been mixed, with most showing the model was not cost effective. The most recent evaluation of the OCM, published in June, found that the program cost Medicare more than $500 million, despite producing some drops in medical costs and a few signals of positive outcomes for patients.

Following "disappointing results" from the OCM, the EOM was designed to promote greater cost savings, Kocher explained in a January JAMA Health Forum Viewpoint. However, in doing so, the EOM raises the financial stakes for participating practices.

In the new model, participating groups will receive significantly less in base monthly payments per patient compared with the OCM — $70 vs $160 — and will accept some financial risk in exchange for a chance to earn a bonus.

The EOM has a two-part payment structure, which requires participants to cover the total cost of care during 6-month episodes of chemotherapy and potentially earn a performance-based bonus if the total cost of care is below an estimated cost benchmark. The flipside is EOM participants may owe CMS a performance-based recoupment of up to 2% if the total cost of care exceeds that benchmark.

"A worrisome feature of the EOM is that the model offers a smaller incentive to participate ($540 less per patient over 6 months relative to the OCM) and a high threshold for earning bonus payments, along with a risk of having to repay" CMS, Kocher explained in the Viewpoint article .

Overall, CMS "hopes that these changes will render the EOM more cost-effective, quality neutral or better, and more equitable," Kocher writes. But "this expectation may prove to be a risky bet."

However, Kocher told Medscape, "I think [the EOM] will be good for patients."

EOM participants must consider patients' costs of care and the potential financial toxicity associated with treatment, providing extra support to practices who treat underserved or lower-income patients. The EOM design also weaves in screening for social needs for patients — assessing transportation, food, and housing needs as well as providing support for patients experiencing social isolation and financial toxicity.

Even with the potential financial risks for practices, the EOM drew more interests from oncologists than expected, said Kocher, also affiliated with Stanford University and the University of Southern California.

"I think it is exciting to see so many oncology practices choose to participate," he noted. While "time will tell if the model proves to be a good economic model" for both oncologists and CMS," it should improve access to care and "lead to better patient experiences and outcomes."

Kerry Dooley Young is a freelance journalist based in Washington, DC. Follow her on Twitter @kdooleyyoung.

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Cite this: Take 2: CMS Launches Successor to the Oncology Care Model - Medscape - Jun 30, 2023.