EOM
Enhancing Oncology Model
The Enhancing Oncology Model (EOM) is a nationwide voluntary payment model that incentivizes oncology practices to deliver coordinated, high-quality, patient-centered care for Medicare beneficiaries receiving systemic chemotherapy. It focuses on seven specific cancer types and aims to improve health outcomes while reducing Medicare spending.
Innovation
EOM requires downside risk for all participants at the start, offers a differential Monthly Enhanced Oncology Services (MEOS) payment based on dual eligibility status, uses a cancer-type specific approach to calculating benchmarks, and gradually requires the use of electronic patient reported outcomes (ePROs).
The Problem
Cancer is a leading cause of mortality in the United States with detrimental costs to patients living with a cancer diagnosis, their families, and the health care system. There continues to be room for improvement in the quality and costs of care such as avoiding unnecessary hospital visits, enhancing end of life care, and shifting to higher-value cancer therapy.
The Solution
EOM incentivizes oncology providers to take on accountability for the total cost of care and the quality of care during oncology episodes. Model participants offer EOM beneficiaries services such as personalized care plans and patient navigation, which can lead to more timely and tailored coordinated care.
Expected Outcomes
EOM aims to drive transformation in oncology care by improving the quality of care delivered to beneficiaries undergoing treatment for cancer including improved health outcomes and patient experiences. The model also aims to reduce spending under Medicare.
Strategy
EOM supports the Innovation Center’s strategic priority of patient empowerment by putting the patient at the center of the care team, as well as protecting federal taxpayers by refining incentives to achieve smarter spending for high-quality care.
Model Goals
- Drive transformation in oncology care by preserving or enhancing the quality of care
- Reduce program spending under Medicare fee-for-service (FFS)
- Put the patient at the center of a care team that provides equitable, high-value, evidence-based care
- Increase engagement of patients, oncologists, and other payers in value-based care and quality improvement
Patient Eligibility
Medicare FFS beneficiaries receiving systemic initiating cancer therapy for one of seven included cancer types.
- Enrolled in Medicare fee-for-service (FFS) receiving Part B or Part D
- Receiving systemic initiating cancer therapy
- Diagnosed with breast cancer, chronic leukemia, small intestine/colorectal cancer, lung cancer, lymphoma, multiple myeloma, or prostate cancer
- Not receiving hormonal therapy only
Provider Eligibility
Medicare-enrolled oncology physician group practices (PGPs) that do not routinely refer to PPS-Exempt Cancer Hospitals.
- Must be a Medicare-enrolled oncology PGP identifiable by a single federal taxpayer identification number (TIN)
- Must include at least one oncology practitioner (specialty code Hematology/Oncology or Medical Oncology)
- Must not routinely refer beneficiaries to PPS-Exempt Cancer Hospitals (PCHs) for chemotherapy services
- Cannot be a Critical Access Hospital (CAH), Federally Qualified Health Center (FQHC), or Rural Health Center (RHC)
Care Categories
Oncology
CMS Benchmarks & Thresholds
eligibility
financial
operational
Operational Friction Summary
Where operational friction is highest for this model.
EOM episodes trigger upon the initiation of systemic chemotherapy for seven specific cancer types, requiring immediate patient navigation and personalized care plan implementation to influence the episode's trajectory.
Oncology practices are accountable for the total cost of care, including non-oncology services, meaning they must track ED visits, hospitalizations, and post-acute care across the entire healthcare system during the 6-month episode.
EOM operates on 6-month episodes where the financial benchmark is heavily influenced by clinical characteristics, requiring precise management of high-cost drugs and end-of-life (EOL) care timing.
While the medical oncologist holds the financial risk for the EOM episode, total cost of care includes services driven by surgeons, radiation oncologists, and primary care providers.
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