HHS Unveils New Alternative Payment Model for Cancer Care

June 28, 2022 - The Biden Administration recently announced a new alternative payment model from the CMS Innovation Center that will focus on improving cancer care quality and total cost of care around treating the chronic condition.

Named the Enhancing Oncology Model, or EOM, CMS said the alternative payment model aims to incentivize providers in oncology practices to treat the whole person, not just a patient’s cancer. This includes addressing a patient’s social needs, reducing care inequities, and gathering patient feedback on care delivery.

EOM is part of President Joe Biden’s Unity Agenda and the reignited Cancer Moonshot initiative, launched under the Obama Administration to accelerate the rate of progress with cancer care. It will also build on the lessons learned from the Innovation Center’s Oncology Care Model, which ends at the end of this month.

“No one should have to battle cancer without access to high quality, coordinated care,” HHS Secretary Xavier Becerra said in an announcement yesterday. “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. We will continue to do all we can to make access to this care equitable and end cancer as we know it.”

EOM is a voluntary alternative payment model launching in July 2023 and ending in June 2028. The model is based on a bundled payment structure in which participating practices will receive a monthly payment to provide “enhanced” services to assigned beneficiaries. Those enhanced services include screening for health-related social needs, patient navigation, care planning, electronic Patient-reported Outcomes (ePROs) implementation, and activities that promote health equity.

EOM practices will also be able to earn a retrospective performance-based payment based on care quality and savings associated with the care they deliver to assigned beneficiaries. However, all practices will be required to take on downside financial risk at the start of the model, meaning providers could lose money if they fail to deliver on care quality and savings goals.

Smaller practices have been particularly hesitant to take on downside financial risk as many lack the resources and capital to manage potential losses. However, CMS aims to get more providers to take on downside risk as part of its Innovation Center strategy refresh. The agency believes that getting more providers to assume financial risk will advance value-based care implementation.

EOM offers two downside risk options for participants, with one containing a risk level high enough for participants to attain Qualifying APM Participant (QP) status under the Quality Payment Program.

With the alternative payments, CMS expects participating practices to redesign cancer care workflows to include not only enhanced services but also 24/7 access to care. Practices will be able to join if they deliver a six-month episode of chemotherapy to Medicare beneficiaries with select types of cancer. The types of cancers covered by the model are breast cancer, chronic leukemia, lung cancer, lymphoma, multiple myeloma, prostate cancer, and small intestine/colorectal cancer.

EOM is also a multi-payer initiative, including private payers, Medicare Advantage plans, and state Medicaid agencies. CMS will divide the model with one part operated by Traditional Medicare and the other by EOM payers. The agency intends for this approach to encourage practices to support attributed cancer patients regardless of their health coverage.

The primary goal of the alternative payment model is to “better support patients and improve their care experience,” according to CMS.