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 for seven specific cancers. The model aims to improve health outcomes and patient experiences while reducing Medicare spending.
Innovation
EOM includes required downside risk for all participants at the start, a differential Monthly Enhanced Oncology Services (MEOS) payment based on dual eligibility status, a cancer-type specific approach to calculating benchmarks, and the gradual requirement to use 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 furnished to beneficiaries
- 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 fee-for-service beneficiaries receiving Part B or Part D systemic initiating cancer therapy for one of seven included cancer types.
- Medicare fee-for-service (FFS) beneficiaries receiving Part B or Part D
- Initiating cancer therapy for a cancer diagnosis of one or more of the seven included cancer types
- Must not be receiving hormonal therapy only
Provider Eligibility
Medicare-enrolled oncology physician group practices (PGPs) identifiable by a single TIN, composed of at least one oncology practitioner.
- Medicare-enrolled oncology PGP identifiable by a single federal taxpayer identification number (TIN)
- Composed of at least one EOM practitioner that is an oncology practitioner
- Must not routinely refer beneficiaries to PPS-Exempt Cancer Hospitals (PCHs) for chemotherapy services
- Must not be a Critical Access Hospital (CAH), Federally Qualified Health Center (FQHC), or Rural Health Center (RHC)
Care Categories
Oncology
Program Benchmarks & Thresholds
eligibility
financial
operational
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