What the Enhancing Oncology Model says about future of value-based care

CMS’s newest value-based care model incorporates lessons learned from past programs and gives valuable insight into what works in the modern healthcare environment.

By admin

Jul 27, 2022, 12:32 PM

Even after a decade of development, value-based care is still evolving. Regulators, payers, providers, developers, and patients are continuously learning how to control costs, improve outcomes, and create positive shared experiences across the care continuum.

During this time of rapid learning, CMS has established an impressive track record for innovation. The agency has also shown admirable responsiveness to the industry and a willingness to adapt and improve when its ideas don’t pan out exactly as planned.

The new Enhancing Oncology Model (EOM) is the latest proof that pivoting quickly and engaging in cross-industry collaboration is the key to making value-based care work.

The EOM model is designed to take over where the five-year Oncology Care Model (OCM) left off in June of 2022. While the OCM program was deemed unsuccessful based on CMS’s specific criteria around program savings, many participants and observers believe the model still brought tangible value to practices and patients.

To build on the bright spots and hopefully achieve greater savings for Medicare in the future, EOM will incorporate lessons learned from OCM and take into account the feedback from stakeholders and participants. If EOM ends up ticking more boxes than OCM, the revamped model may provide an important blueprint for future value-based care initiatives.

Here are a few features of EOM that have shown promise in previous programs and are strong candidates to carry over into future value-based care models for additional specialties and provider types.

Refining incentive opportunities to support ongoing care transformation

Just like OCM, the EOM program will continue to offer a two-part incentive structure. Participants can bill for a Monthly Enhanced Oncology Services (MEOS) payment for each patient, assuming the practice meets the requirements to provide specific services. Participants can also earn retrospective performance-based payments for meeting quality and spending targets.

This approach ensures that participants can regularly bring in enough revenue through the model to deliver an ambitious set of data-driven, patient-centered care services, such as the use of data for quality improvement and the eventual use of electronic patient-reported outcomes (ePRO) data for decision-making.

The twin tracks also create opportunities to bump up earnings through high performance, motivating practices to make measurable improvements in key areas and continue to work their way toward the best possible quality care.

Notably, EOM requires all participants to shoulder a degree of downside risk from the very beginning of the program. CMS has been significantly ramping up efforts to nudge practices into two-sided risk arrangements, and there’s almost no question that taking on risk earlier in the process will be a standard component of models to come.

Including a smaller number of eligible episodes of care

Defining an episode of care can be challenging, leading to questions over who is responsible for what parts of the patient journey – and who should be earning incentives for the outcomes of those patients.

OCM took a broad approach to eligible conditions, while EOM is limiting its scope to six-month episodes of systemic chemotherapy for just seven types of common cancers: breast cancer, chronic leukemia, colorectal cancer, lung cancer, lymphoma, multiple myeloma, and prostate cancer.

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Creating clear, narrow, manageable definitions for inclusion in the model could help practices better understand their clinical and financial opportunities and may encourage more organizations to participate. This is easier in specialty models than primary or acute care models, however, and regulators will need to carefully think about how to apply similar techniques to less well-defined areas of practice.

Treating health equity as a central pillar of the patient experience

OCM had no specific focus on health equity, but EOM is making access to care, health literacy, and patient experiences into its top priority. Participants can only earn their monthly payments if they engage in certain health equity activities, such as 24/7 access to care and health records, social needs screenings, and patient navigation and care planning.

This push toward equity aligns well with recent efforts across the industry to reduce disparities and improve access to high-quality care. There’s little doubt that subsequent iterations of value-based care programming will do the same.

When combined with tweaks to the incentive structure and a heavier reliance on data-driven decision making, the emphasis on health equity creates an encouraging environment for better care, lower costs, and improved patient experiences.

Over the next five years, the industry will eagerly watch the EOM program to see if it produces the desired results and will undoubtedly incorporate its most successful components into the next generation of value-based care models.

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Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry. Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.