Medicare Innovation Center Announces New Oncology Payment Model

June 27, 2022

On June 27, 2022, the Centers for Medicare & Medicaid Services (CMS), through its Center for Medicare & Medicaid Innovation (CMMI), announced a new, voluntary oncology payment model, the Enhancing Oncology Model (EOM).

EOM is a 5-year, voluntary payment model, set to begin on July 1, 2023. Under EOM, participating oncology practices will take on financial and performance accountability for episodes of care surrounding systemic chemotherapy administration to patients with seven common cancer types: breast cancer, chronic leukemia, small intestine/colorectal cancer, lung cancer, lymphoma, multiple myeloma, and prostate cancer. EOM participants will be responsible for the total cost of care during a 6-month episode and will elect to participate in one of two, two-sided financial risk arrangements.

EOM employs specific design elements, including comprehensive, coordinated cancer care; data-driven continuous improvement; 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.

EOM participants will be required to implement 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. As part of the data reporting for quality improvement, EOM participants will also submit health equity plans to CMS, where participants will detail evidence-based strategies to mitigate health disparities identified within their beneficiary populations.

ASCO is pleased that CMMI is proposing EOM as a voluntary model and that practices will be able to choose to participate based on their level of readiness and ability to assume financial risk. We also fully support CMMI’s focus on equity and coordinated cancer care. However, we are concerned that CMMI has proposed a sizeable reduction in MEOS payments compared to similar payments in the Oncology Care Model (OCM). This is especially concerning given that there will be a gap of a year between the end of OCM and the start of EOM, during which time practices will receive no additional support for the mechanisms instituted during OCM to enhance patient access and care coordination that will continue under EOM.

A detailed payment methodology paper will be published for EOM in the summer of 2022 and will be available on the Innovation Center’s website.

The application period for EOM is currently open. All EOM applications must be submitted by 11:59 PM Eastern Daylight Time on September 30, 2022.

For more information, including the Request for Applications, please see the Innovation Center’s EOM website.

Bookmark ASCO in Action for updates and additional analysis on EOM.