An improvement over OCM?
The OCM represented the largest alternative payment model to address value-based payment for cancer care. More than 3,200 oncologists and 201 physician practices voluntarily entered the program, which lasted 6 years.
But since its implementation, studies assessing the success of the program have yielded mixed results.
A 2018 analysis, for instance, revealed that one large community practice saved Medicare $3 million over a year after adopting the OCM.
However, a 2021 study found that, while community practices experienced lower drug costs in lung and prostate cancer and lower office-based costs after implementing the program, the difference was not statistically significant when accounting for all costs.
Another analysis also revealed more mixed results, reporting cost reductions for all cancers, but also finding those savings were offset by administrative expenses. Overall, this study found the OCM led to a $155 million net loss to Medicare over 4 years.
Will the EOM improve upon the OCM?
According to the CMS, “the central goal of EOM is to better support patients and improve their care experience.”
Participating Physician Group Practices will take accountability for health care quality and total spending during 6-month episodes of care for Medicare patients with certain cancers.
CMS will give participants the option to bill for Monthly Enhanced Oncology Services payment for services provided to eligible beneficiaries. This payment will be higher for beneficiaries dually eligible for Medicare and Medicaid.
EOM participants will have the opportunity to earn a retrospective performance-based payment 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.
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, screening for health-related social needs, use of data for quality improvement, and use of certified electronic health record technology.
“No one should have to battle cancer without access to high-quality, coordinated care,” said Health & Human Services Secretary Xavier Becerra, in a statement. “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.”
A detailed payment methodology paper will be published for EOM this summer and will be available on the Innovation Center’s website.
A version of this article first appeared on Medscape.com.