EOM builds on lessons learned from the Oncology Care Model (OCM), which ran from July 1, 2016-June 30, 2022. Practices made transformations under OCM, like standardized screening for pain and depression and improved communication with patients to improve the quality of care delivered to Medicare beneficiaries.
EOM continues to offer Monthly Enhanced Oncology Services (MEOS) payments that help providers implement value-based, patient-centered services such as round-the-clock access to a clinician, patient navigation, and comprehensive care plans that facilitate shared decision-making between the patient and their care team.
EOM focuses on a narrower set of high-risk cancer types and includes refinements informed by OCM evaluation results and feedback from OCM participants, OCM patient advocacy groups, and other oncology stakeholders. Key changes include cancer type-specific benchmarking, stronger financial accountability for participants, and new care transformation activities such as collection of electronic patient-reported outcomes (ePROs) and screening for health-related social needs (HRSNs).
Background
EOM blends financial accountability, monthly care transformation support, and person-centered care requirements to reform payment and care delivery in oncology. In EOM, participating Physician Group Practices (PGPs) take on accountability, including downside risk, for health care quality and total spending during six-month episodes of care for Medicare patients receiving systemic treatment for seven cancer types. PGPs may coordinate with other specialists, primary care providers, community organizations, social workers, or psychologists to promote whole-person care.
Model Aims
The primary purpose of EOM is to test whether aligning payment with evidence-based, person-centered care can improve health outcomes and patient experience, reduce unnecessary utilization and spending, and improve oncology care for Medicare beneficiaries.
Innovation
EOM encourages innovation in the delivery, coordination, and personalization of oncology care. EOM supports these care transformation activities with MEOS payments, helping oncology practices of all sizes to innovate while staying competitive in a value-based environment.
By holding practices financially accountable for the total cost of care and requiring participants to take on downside risk, EOM helps ensure that Medicare dollars are being spent efficiently, reducing waste while improving care.
Design
An episode begins when a Medicare beneficiary starts chemotherapy for breast cancer, chronic leukemia, small intestine/colorectal cancer, lung cancer, lymphoma, multiple myeloma, or prostate cancer. Each episode lasts six months, and beneficiaries whose treatment extends beyond six months may have multiple episodes if they continue to receive chemotherapy. CMS sets spending benchmarks based on historical costs and patient characteristics such as preexisting health conditions. EOM rewards participants who perform well on cost and quality metrics with performance-based payments.
Payment Structures
EOM includes two main payment structures:
Monthly Enhanced Oncology Services (MEOS) Payments
- Practices receive $110 per beneficiary per month (or $140 per beneficiary per month for dually eligible individuals)
- These payments support care transformation activities like patient navigation, 24/7 clinician access, comprehensive care planning, screening for health-related social needs (HRSNs), and use of electronic patient-reported outcomes (ePROs).
Performance-Based Payment (PBP)
- Participants are financially accountable for total Medicare spending during each six-month episode.
- If the participant holds total spending below a target amount while meeting quality metrics, they share in the savings.
- If total spending exceeds a certain threshold, the participant must repay CMS a portion of the excess.
Required Care Design Activities
Practices are required to implement eight core participant redesign activities (PRA), including:
- 24/7 access to a clinician with EHR access
- Patient navigation
- Evidence-based treatment guidelines
- Comprehensive care plans
- Screening for social needs
- Collection and monitoring of electronic patient reported outcomes (ePROs)
- Use of data for continuous quality improvement
- Use of certified EHR technology
Quality & Data Reporting
Practices are required to submit data on quality measures, clinical and sociodemographic data. CMS provides regular reports to model participants on spending, utilization, and quality performance, as well as associated claims data.
