Overview
The Enhancing Oncology Model (EOM) is a voluntary payment model intended to transform care for cancer patients. It is designed to test how best to place cancer patients at the center of the care team that provides high-value, equitable, evidence-based care. EOM aims to improve care coordination, quality, and health outcomes for patients while also holding oncology practices accountable for the total cost of care to make cancer care more affordable and accessible for individuals while reducing Medicare spending.
Timeline
EOM is launching a second application period. The second cohort of EOM participants will begin on July 1, 2025. The Request for Applications (RFA) with detailed information about participation in the model and the design of EOM is available on the EOM webpage beginning May 30, 2024. The application portal for interested applicants will be open from July 1, 2024, to September 16, 2024. Further details on how to apply are forthcoming.
The model performance period for the first model cohort began on July 1, 2023. The model will end on June 30, 2030, which includes a two-year extension from the original end date of June 30, 2028.
Key Elements of the EOM Design
Under EOM, participating Physician Group Practices (PGPs) take on accountability for their patients’ health care quality and total spending during six-month episodes of care for Medicare patients with certain cancers.
- EOM focuses on individuals receiving systemic cancer treatment (that is, not individuals receiving hormonal therapy only) for seven cancer types: breast cancer, chronic leukemia, small intestine/colorectal cancer, lung cancer, lymphoma, multiple myeloma, and prostate cancer.
- CMS gives participants the option to bill for a Monthly Enhanced Oncology Services (MEOS) payment for Enhanced Services provided to eligible individuals. The MEOS payment is higher for individuals who are dually eligible for Medicare and Medicaid. Patients are not responsible for cost sharing for the EOM MEOS payment.
- EOM participants can earn a retrospective performance-based payment (PBP) based on quality of care and savings. Participants are required to take on downside risk from the start of the model (with the potential to owe CMS a performance-based recoupment (PBR)).
- EOM participants are required to implement patient-focused participant redesign activities, including 24/7 access to care, patient navigation, care planning, use of evidence-based guidelines, use of electronic Patient Reported Outcomes (ePROs), screening for health-related social needs, use of data for quality improvement, and use of certified electronic health record technology.
- EOM embeds health equity in all aspects of model design and implementation. EOM participants screen patients for health-related social needs, collect and have access to additional data to better identify health disparities, and develop iterative plans to address identified disparities and promote health equity.
- EOM is a multi-payer model. Private payers, Medicare Advantage plans, and state Medicaid agencies are invited to apply for the model and to enter into a Memorandum of Understanding (MOU) with CMS. There are two parts of EOM: one operated by CMS for Medicare fee-for-service (FFS) and another operated by EOM payers for their enrollees who are patients of an EOM participant.
EOM Design Updates for 2025
CMS has made several updates to the design of EOM that will be applicable to current participants (cohort 1) and the new cohort of participants (cohort 2). Updates to the model’s design include:
- For individuals who are not dually eligible, increasing the base amount of the MEOS payment from $70 per individual per month to $110 per individual per month,
- For individuals who are dually eligible for Medicare and Medicaid, the total MEOS payment increases from $100 per individual per month to $140 per individual per month, and
- Requiring participants to pay back to CMS costs related to their patients’ care when they exceed their benchmark amount for episodes of care, as opposed to starting paybacks when costs exceed 98% of their benchmark.
These model design updates will be effective starting on January 1, 2025, for current EOM participants and on July 1, 2025, for the new cohort of EOM participants.
Purpose of the Model
Under EOM, participants are incentivized to consider the whole patient and engage with them proactively during and between appointments. Section1115A of the Social Security Act (the Act) (added by Section 3021 of the Affordable Care Act) (42 U.S.C. § 1315a) established the Innovation Center to test innovative payment and service delivery models that have the potential to reduce Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) expenditures while preserving or enhancing the quality of individuals’ care. Under Traditional Medicare FFS, oncology providers and suppliers generally receive separate payments for each item or service furnished to an individual during their cancer treatment. This creates a financial incentive for some providers and suppliers to increase the volume of items and services or prescribe high-cost, but not necessarily higher-value, drugs. These actions may adversely affect the individual with cancer and the Medicare program.
In addition, cancer care has traditionally focused on treating the disease and not the person, resulting in fragmented care (e.g., the oncologist’s focus on the patient is typically limited to the time when they are in an exam room with limited coordination with other providers involved in a patient’s care). EOM aligns payment incentives with care quality, encouraging EOM participants to improve quality by implementing participant redesign activities.
EOM also aligns with President Biden’s Cancer Moonshot pillars and priorities of supporting patients, caregivers, and survivors, as well as addressing inequities. On February 2, 2022, the Biden-Harris Administration reignited the Cancer Moonshot effort by setting a goal of reducing the cancer death rate in half over the next 25 years and improving the experience of people and their families living with and surviving cancer. Several agencies, including CMS, have sustained progress toward these goals.
How EOM Supports Cancer Patients
Patients whose health care providers are participating in EOM may communicate better with their oncologist and care team in between appointments and be able to more easily reach them with questions. Participants may provide their patients with enhanced, patient-focused services, such as:
- 24/7 access to an appropriate clinician with real-time access to patient medical records.
- Patient navigation services (e.g., facilitating linkages to follow-up and/or support services, providing access to clinical trials as medically appropriate).
- Detailed care plans involving discussions with patients about prognosis, treatment options, symptom management, quality of life, and psychosocial health needs, among other topics.
- Electronic patient reporting of overall cancer care experience, health-related social needs, and health outcomes, such as those related to their symptoms, physical functioning, and behavioral health.
Quality Payment Program (QPP) Risk Arrangement Options
EOM includes two risk arrangements with different levels of downside risk. Both EOM risk arrangements qualify as a Merit-based Incentive Payment System (MIPS) Alternative Payment Model (APM) under the QPP as of July 2023, and the risk arrangement with increased downside risk (Risk Arrangement 2) meets the criteria to be an Advanced APM under the QPP as of July 2023.
For more information on QPP, visit https://qpp.cms.gov/.
For more information on EOM, visit the EOM main web page.