Health Policy Updates

CMMI Announces New Oncology Model

Voluntary, five-year Enhancing Oncology Model scheduled to start July 1, 2023

On June 27, the Centers for Medicare and Medicaid Services (CMS) Innovation Center announced a new, voluntary Enhancing Oncology Model (EOM). EOM is a five-year model scheduled to start on July 1, 2023 and end on June 30, 2028. CMMI will be accepting applications for EOM from physician group practices (PGPs) through September 30, 2022.

Key elements of the EOM design include:

• Participating PGPs will take on accountability for their patients’ health care quality and total spending during six-month episodes of care.
• EOM will focus on beneficiaries receiving systemic chemotherapy (not those receiving hormonal therapy only) for seven cancer types: breast cancer, chronic leukemia, small intestine/ colorectal cancer, lung cancer, lymphoma, multiple myeloma, and prostate cancer.
• Participants will be able to bill for a Monthly Enhanced Oncology Services (MEOS) payment for Enhanced Services provided to eligible beneficiaries ($70 base MEOS payment per EOM beneficiary per month; $100 per dually eligible beneficiary per month).
• Participants will be able to earn a retrospective performance-based payment (PBP) based on quality and savings.
• Participants will be required to take on downside risk from the start of the model (with the potential to owe CMS a performance-based recoupment).
• Participants will select from two risk arrangements with different discounts, targets, downside risk, and upside risk.
• 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.

EOM is aligned with the Biden-Harris Administration’s effort to meet its Cancer Moonshot goal of improving the experience of people living with cancer by supporting and learning from cancer patients, caregivers, and cancer survivors, addressing inequities, and providing the right treatments to the right patients.

To read The Network’s statement on EOM, CLICK HERE.

To visit the dedicated CMMI EOM website, CLICK HERE.

To read the EOM Fact Sheet, CLICK HERE.

To read the EOM Request for Applications, CLICK HERE.

Published June 27, 2022