On June 27, the Biden Administration, through the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS), announced a new model aimed at improving cancer care for Medicare patients and lowering health-care costs. CMS’ Center for Medicare and Medicaid Innovation (Innovation Center) designed the Enhancing Oncology Model (EOM) to test how to improve health-care providers’ ability to deliver care centered around patients, consider patients’ unique needs, and deliver cancer care in a way that will generate the best possible patient outcomes.
The model will focus on supporting and learning from patients, caregivers, and survivors, while addressing inequities and providing patients with treatments that address their unique needs. This new model supports President Joe Biden’s Unity Agenda and Cancer Moonshot initiative to improve the experience of people and their families living with and surviving cancer.
“No one should have to battle cancer without access to high quality, coordinated care,” said HHS Secretary Xavier Becerra. “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. We will continue to do all we can to make access to this care equitable and end cancer as we know it.”
“There are stark inequities in the ability of people with cancer across race, gender, region, and income to access cancer screening, diagnostics, and treatment,” said CMS Administrator Chiquita Brooks-LaSure. “CMS is working to advance President Biden’s Cancer Moonshot goals by helping [patients with cancer utilizing] Medicare [to] better navigate a challenging and often overwhelming journey. The Enhancing Oncology Model will incentivize participating oncology practices—including those in rural and underserved areas—to improve the provision of high-quality, coordinated care that addresses patients’ social needs and improves patient and caregiver support.”
More on the EOM
Building on the lessons learned from the Innovation Center’s Oncology Care Model (tested from July 1, 2016–June 30, 2022), EOM is a voluntary model that will run for 5 years, from July 2023 through June 2028. Model participants will include oncology practices that treat people with Medicare undergoing chemotherapy for breast cancer, leukemia, lung cancer, lymphoma, multiple myeloma, prostate cancer, and small intestine/colorectal cancer.
To support health-care transformation, participating providers will also provide enhanced services such as patient navigation; care planning; collection of electronic patient-reported outcomes; and screening for social needs that may affect treatment, such as transportation issues and nutritional needs. EOM will also encourage other payers (eg, commercial payers, state Medicaid agencies) to align with its core concepts to promote a consistent approach across payers and EOM participants’ patient population.
The central goal of EOM is to better support patients and improve their care experience, advancing a key goal of the Cancer Moonshot Initiative. Oncology practices who participate in EOM can expect to provide patient-focused enhanced services, such as 24/7 access to a clinician, patient navigation services, a detailed care plan, and screenings for health-related social needs. Patients will also have an opportunity to share feedback on their overall cancer care experience and health outcomes. EOM aims to increase and improve communications among patients, oncologists, and care teams in between appointments and enable patients to more easily reach their health-care providers with questions.
In addition to requiring participants to screen for health-related social needs, EOM includes other design elements that help drive CMS’ commitment to advancing health equity, including:
- Offering an additional payment to participating oncology practices that provide enhanced services to patients who qualify for both Medicare and Medicaid
- Requiring participating providers to report patient demographic data (eg, race, ethnicity, language, gender identity)
- Requiring participating providers to develop plans showing how they will address health equity gaps in their patient population.
A fact sheet on EOM is available, and for oncology practices interested in participating in EOM, there is a live request for applications. All EOM applications must be submitted by 11:59 PM EST on September 30, 2022.
More information on the Enhancing Oncology Model is available at innovation.cms.gov/innovation-models/enhancing-oncology-model.
