Five Reasons to Participate in the New Enhancing Oncology Model

Key takeaways:

• The Centers for Medicare & Medicaid Services (CMS) announced a new payment model aimed at improving care coordination, enhancing the care experience and lowering costs for cancer treatments.
• Participation in the Enhancing Oncology Model (EOM) is voluntary for Medicare-enrolled physician group practices. Those that wish to participate must submit their application by Sept. 30, 2022.
• PINC AI™ Value-Based Care consulting experts break down all the details for eligible oncology practices and share five benefits of participation.

The recently announced Enhancing Oncology Model (EOM) is expected to begin July 1, 2023. The five-year, voluntary EOM builds on lessons learned from the Oncology Care Model, and is designed to enable high-value cancer care that improves quality and outcomes, while reducing Medicare expenditures for oncology patients.

The EOM will include seven high-volume cancer types treated with systemic chemotherapy. Similar to the Oncology Care Model, EOM is inclusive of all services furnished during a six-month episode.

Physician group practice participants will be required to focus on eight patient-focused practice redesign activities: screening for health-related social needs; using electronic Patient Reported Outcomes (ePRO), certified electronic health record technology, evidence-based guidelines and data to improve quality of care; and providing additional services such as 24/7 access, care planning and patient navigation.

By requiring the care team to provide equitable, high-value, evidence-based care, this model reinforces a holistic view of each patient’s journey as they navigate cancer treatment.

Why You Should Apply for the New Cancer Care Model

PINC AI ™ Value-Based Care consulting experts see five advantages to participating in the model.

• Participation in the EOM would offer a vehicle to drive and expand existing patient-centered care goals that align with a host of other oncology certifications and accreditations, creating an umbrella program under which a health system can combine a host of interrelated goals. Moreover, the model encourages providers to improve the cancer experience for both the patient and the care team for improved overall satisfaction. Using tools such as shared decision making, comprehensive care plans, ePROs, patient navigators and the introduction of early palliative care increases the level of patient and caregiver satisfaction, while providing the professional care team with valuable information to make the best decisions for treatment.

• For oncology practices that have not yet begun a value-based care journey, the EOM would offer a unique opportunity to get started while also receiving a new revenue stream through Monthly Enhanced Oncology Services (MEOS) payments. MEOS payments are newly available claims designed to support practice transformation specific to this model. The additional payments available through the EOM equate up to $420 per non-dual beneficiary and up to $600 per dual beneficiary, per episode. An oncology practice with an average of 350 Medicare beneficiaries triggering an episode with a qualifying cancer treatment per year could anticipate additional revenue between $735,000 to $1,050,000 over the five years, assuming a mix of Medicare and dual-eligible (Medicare and Medicaid) beneficiaries. These added payments can not only help systems transform care models and transition to more value-based care, but also provide valuable net new dollars that can help offset rising prices due to inflation and the added costs of labor. For oncology practices that have experience in value-based models, this is a chance to enhance the commitment to value-based care and diversify your contract portfolio, in addition to capturing a new revenue stream through MEOS payments.

• The EOM does require taking on financial risk through a reconciliation process that compares actual expenditures to a target price, with adjustments for quality performance. There are two options with varying levels of risk. Each level of risk also contains a neutral zone providing some additional financial protection within this model. Due to the financial accountability, there is an opportunity to qualify as a Merit-based Incentive Payment System (MIPS) Alternative Payment Model (APM) or an Advanced APM in the Quality Payment Program (QPP), depending upon the selected risk track, and unlocks an additional opportunity to capture bonus payments through that program. Qualification as either a MIPS APM or an Advanced APM would also alleviate the administrative burden related to MIPS reporting by reducing the measures or exempting your practice from reporting.

• With a model emphasis on health equity and reducing health disparities, your practice will be at the forefront of promoting health for all within your community. Identifying and addressing the social needs of your population is critical for delivering optimal care and ensuring patient compliance. Through the EOM, you will have the added flexibility to utilize waivers that help eliminate barriers and issues with access to care by making it easier to provide care to patients outside a facility and in the home or place of residence.

• Another big draw of this model is the access to invaluable claims data. The data will allow you to have visibility into the patient’s care journey within and outside of your practice, giving you clear insight into managing the whole patient. Patient trends, referral patterns and resource utilization information will drive your practice towards improved outcomes.

PINC AI™ consultants are offering support to members throughout the application process and will support EOM participants in the spring of 2023 with an Enhancing Oncology Care Cohort within existing performance improvement collaboratives.

The EOM application is due Sept. 30, 2022. What are you waiting for? Apply today and let the Enhancing Oncology Model help you transform the way you deliver oncology care.

Learn more about how Premier can support your value-based care journey.

The insights you need to stay ahead in healthcare: Subscribe to Premier’s Power Rankings newsletter and get our experts’ original content delivered to your inbox once a month.